Prior Authorization Navigator

Scope of Position

The Pharmacy Prior Authorization Navigator (P-PAN) position is responsible to provide efficient and efficacious care to oncology patients serving as the single point of contact for the clinic, including completing prior authorizations, coordination of all medication access and financial counseling related activities, and communicating with patient and clinic teams. The focus will be providing advanced review and education to clinic to alert of medication access related issues and assuring accurate and timely submission, intervention, follow up, and documentation of prior authorizations. This position requires strong clinical and an expert level of payor requirement knowledge, and the ability to use and work with high proficiency in the Integrated Health Information Systems (IHIS). In addition, this position provides support through education and communication to other departments such as Financial Counseling, MIM, PCRMs, Physicians, Nurse Practitioners, PAs, and other clinical personnel. The individual must be able to identify trends and offer suggestions for process improvement to streamline workflows and coordinate with medication assistance to ensure patients access to needed medications.

MINIMUM QUALIFICATIONS

Experience with Windows, Microsoft Office, and Intranet/internet navigation tools. Advanced knowledge of Medicare and commercial insurance reimbursement expected along with strong knowledge of ICD-10 codes. Excellent verbal and written communication skills required. Advanced competency in the use of computer-based research and medical record documentation required. Associate or bachelors degree is preferred. Professional licensure in other health-care discipline or PTCB certification required.Minimum 1-2 years of pharmacy prior authorization experience preferred.