Prior Authorization Specialist - Medication - Jamestown, NY

Department: Pharmacy

Position Status: Non-exempt

FLSA Level: Varies

Position Summary

The Pharmacy Third-Party specialist focuses on managing and resolving issues related to the third-party insurance claims and billing in a pharmacy setting. this position will be able to pick their main location between our Jamestown or Dunkirk location.

Supervisory Responsibilities

• None

Essential Functions/Responsibilities of the Position

• Ensuring accuracy and completeness of information for timely and accurate reimbursement.
• Investigating and addressing rejected claims, working with insurance companies to obtain necessary information, corrections and prior authorizations.
• Ensuring timely payment and resolving any discrepancies.
• Keeping detailed records of claims, billing and reimbursements while staying up to date on insurance company policies and procedures.
• Acting as a point of contact between the pharmacy staff, patients and insurance companies.
• Assisting pharmacy staff and patients with billing related questions or issues.
• Contributing to the development of effective billing practices.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Other duties as assigned.

Position Qualifications

EDUCATION

• High School Diploma or equivalent General Education Development (GED) certificate

EXPERIENCE (Years & Certifications)

• Certified Pharmacy Technician (CPhT) preferred

SKILLS

• Strong understanding of medical terminology and pharmacy-related concepts.
• Customer service skills to handle patient needs effectively and efficiently.
• Proficiency in Microsoft Office Suite.
• Ability to work independently or as part of a team.
• Capability to identify problems, analyze options and implement effective strategies to overcome obstacles.
• Ability to manage multiple tasks, prioritize workload and maintain accurate records.
• Capacity to handle fast paced environment to meet deadlines.

Position Requirements and Working Conditions

Physical Activities

Frequency

(N)Never - 0%, (O)Occasionally - 50% or (C)Constantly - 100%

Ascending or descending stairs and the like.

N

Remaining in a stationary position, often standing or sitting for prolonged periods.

C

Moving about to accomplish tasks.

O

Communicating with others to exchange information.

C

Repeating motions that may include the wrists, hands and/or fingers.

C

Travel to meet with various stakeholders

N

Assess risk, detect risk factors for site safety purposes through being aware of surrounding environment, individuals, noises, observations, etc.

N

Environmental Conditions

Low temperatures.

N

High temperatures.

N

Outdoor elements such as precipitation and wind.

N

Noisy environments.

N

Hazardous conditions.

N

Poor ventilation.

N

Small and/or enclosed spaces.

N

Adverse environmental conditions expected.

N

Physical Demands

Sedentary work that primarily involves sitting/standing.

C

Light work that includes moving objects up to 20 pounds.

N

Medium work that includes moving objects up to 50 pounds.

N

Heavy work that includes moving objects up to 100 pounds or more.

N

EEO Statement

The Chautauqua Center is an Equal Opportunity Employer and considers all candidates for employment regardless of race, color, national origin, religion, sex, age, disability, citizenship, pregnancy, military status, marital status, sexual orientation, or any other characteristics protected by law.