"Alerted.org

Job Summary: Responsible for all activities involved in obtaining highly complex authorizations for outpatient oncology medications prior to treatment. Must be knowledgeable and have a thorough understanding of insurance payers with regards to Coordination of Benefits, authorization guidelines, pharmacy / medical benefit differences, and Site of Care Policies. Responsible for reading and interpreting various complex medical records to obtain authorizations for requested services and treatment plans. Communication with clinic staff, providers, pharmacists, and insurance companies is essential to ensure completed peer reviews, relay updated medical and specialty drug policies, and appeals. Review reimbursement and denials to ensure all denials and/or contractual adjustments have been reviewed and assess opportunities for retroactive authorizations/appeals in coordination with financial services. Interacts with all levels of medical team, retail pharmacies, and other healthcare providers and entities to discuss relevant patient information as warranted. Ability to perform accurate calculations and reports. Ability to perform prior to admission medication list collection from patients. Support in the training of new pharmacy technicians. Other duties as assigned.

Qualifications: High School Diploma or equivalent. 1-year prior pharmacy work experience required. Prior experience with insurance, coding, or oncology preferred. Active Pharmacy Technician Certification (CPhT) is required within 18 months of hire. Proficient typing skills. Annual Registration with the NC State Board of Pharmacy is required. A new Pharmacy Technician hired but not already registered with the NC Board has 30 days from hire date to comply. Must have strong organizational skills with initiative, creativity, and public speaking skills. Requires ability to work in a self-directed environment with the ability to network, organize and coordinate a patient care team.

EOE AA M/F/Vet/Disability