Pharmacy Authorization Specialist
Ridge, NY
Hours: Monday through Friday 8:30 to 5:00

Why Join Us?

In this role, you will:

• Run and work daily Business Office Report in OncoEMR for drug order values: POD Verify and
• NYCBS Pharm Fill for current date of service and one week out to be worked to obtain prior
• authorizations. All STAT orders are to be worked immediately upon request by onsite team.
• Work daily requests from onsite pharmacy dispensaries to obtain prior authorization on
• requested medication.
•  Document notes in the Sig Box of OncoEMR in the patient’s treatment plan including approval
• status or in text note where applicable. Must document all steps taken in research/process of the
• case
• Prepare appeals for denials on prior authorization requests where applicable.
• Refer prescription fill requests that are denied or that have a patient financial responsibility to the
• pharmacy financial counselor for review.
• Ensure that all aspects of approval have been checked regarding prior authorization, pre-
• determination, and pre-certification before approving the order as meeting NYCBS policy.
• Verify patient’s own drug with pharmacy related queries where applicable.
• Notify Nursing Management if orders need to be changed to BB (patient’s own drug) or to
• Buy/Bill (billing through medical insurance)
•  Work any prior authorization requests from local pharmacies on patient’s oral medications or on
• specialty pharmacy drugs.
• Maintain and ensure the confidentiality of all patient and employee information at all times.
•  A pharmacy authorization specialist will be expected to work when given sufficient notice of
• Required overtime.

We require:

• High school or GED required.
• Experience in pharmacy / authorization field.
• Experience working in the healthcare field, preferably in a clinical setting or business office.
• Experience in insurance requirements and medical terminology ICD-10 and CPT coding.
• Experience in billing practice management systems, electronic medical record systems, Microsoft
• Word, and Microsoft Excel.
• Excellent verbal and communication skills between co-workers, physicians, management staff,
• patients, insurances, outside programs.
• Ability to multitask, problem solve, utilize basic math skills and follow complex instructions.
• Must have ability to converse in a calm and friendly manner.
• Able to relate and comfort patients during a difficult time.

What we offer: