This is a full-time REMOTE position with benefits. The candidate must reside in Washington State. The candidate must be able to train at the Clinic and attend the annual in-person All Staff meeting.
PRIMARY ROLE OBJECTIVE:
This role is responsible for managing prior authorizations and processing medication refills, ensuring patients receive timely access to necessary medications. The ideal candidate will have experience in pharmacy workflows, insurance approvals, and electronic health record (EHR) systems. This position is open to Certified Medical Assistants (CMAs), Licensed Practical Nurses (LPNs), and Certified Pharmacy Technicians (CPhTs) who have experience in medication management and prior authorizations.
MAIN DUTIES & RESPONSIBILITIES:
Submit and track medication prior authorization requests with insurance companies.
Follow up on pending authorizations and escalate appeals when necessary.
Communicate authorization approvals, denials, and required next steps to providers and patients.
Process prescription refill requests while ensuring accuracy and adherence to provider guidelines.
Confirm medication appropriateness and compliance with clinical protocols before submitting refills.
Collaborate with providers to secure approval for medication renewals or modifications.
Coordinate with pharmacies to ensure smooth dispensing and address any prescription issues.
Maintain accurate and thorough records in the EHR system.
Educate patients on their medication status, prior authorization requirements, and next steps.
Work closely with healthcare providers, pharmacists, and insurance representatives to resolve medication access barriers.
KNOWLEDGE, SKILLS & ABILITIES:
Minimum 1-2 years of experience in prior authorizations and medication refill processing
Strong understanding of insurance policies, formulary restrictions, and pharmacy workflows.
Proficiency in EHR systems and prior authorization platforms.
Exceptional organizational skills, attention to detail, and ability to multitask in a remote setting.
Excellent written and verbal communication skills.
Ability to work independently in a remote environment with minimal supervision.
Familiarity with telehealth platforms and electronic communication tools.
ELIGIBILITY QUALIFICATIONS:
Candidates must hold one of the following valid licenses or certifications:
Certified Medical Assistant (CMA, RMA, CCMA)
Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)
Certified Pharmacy Technician (CPhT)
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