The Pharmacy Prior Authorization Coordinator (Pharmacy Technician III) ensures that all authorizations/certifications for drug therapy are completed in accordance with payer criteria and policy, in a timely manner, and prior to therapy initiation. This position will work with stakeholders inside and outside of the pharmacy department to complete crucial and complex tasks relating to patient care, financial and billing practices, or regulatory compliance.
This is a full-time position with a schedule of Monday through Friday, 8:30am to 5:00pm PT. There is also potential for this role to be hybrid or fully remote, depending on business needs and team approval.
Responsibilities
- Performs complex and unique duties within the pharmacy department
- Interpret, evaluate, and summarize information and datasets of varying sizes
- Communicate effectively and professionally with stakeholder inside and outside of pharmacy department
- Develop and maintain internal (within Fred Hutch) and external relationships (such as vendors, payors, distributors)
- Work independently and within teams to complete tasks
- Documentation information or results in clear and concise ways
- Generate and present reports of tasks to Pharmacy Operations Manager or Director of Pharmacy
- Other duties as assigned
- Determine benefit limits and secure insurance approvals for specialty infusion, oral chemotherapy and high-cost medications
- Work closely with care team to communicate any coverage issues
- Evaluate patterns in denied claims taking corrective action and educating staff as needed
- Liaison with Patient Financial Services
- Serve as a resource to patients and staff regarding insurance and drug coverage questions
- Provide patient assistance program information and education to providers, patients and medical center staff
- Completing and submitting prior authorization forms and patient assistance applications
- Reprocessing denied or rejected third party claims
- Train and educate staff on pharmacy billing functions
- Participate in billing related meetings
- Retail pharmacy reconciliation and reporting
- Other pharmacy related duties in accordance with regulations under Washington State Pharmacy Quality Assurance Commission
Qualifications
Required:
- High school diploma or equivalent
- Current Washington state pharmacy technician certification.
- 2 years pharmacy technician experience
- Proficient in Microsoft suite
- Ability to communicate verbally in person, on the phone, and in writing in a clear, concise and professional manner
- Ability to use a mouse, navigate computer programs, enter data into computer systems accurately and efficiently
- Attention to detail and accuracy documentation of information
- Ability to multitask and work efficiently in a dynamic work environment
- Ability to work effectively as a member of a team
- Experience with electronic medical records
- Familiar with the generic names of drugs along with their basic indication
- Able to perform basic pharmaceutical calculations
- Review and correct discrepancies identified in daily, weekly and monthly billing reports
- Ability to work in a fast paced and complex environment
Preferred:
- Previous experience in pharmacy billing/prior authorization
- Knowledge of CPT, ICD-10 and other medical terminology
- Knowledge of the health care environment and electronic medical records
- Attention to detail and accuracy documentation of information
- Ability to multitask and work efficiently in a dynamic work environment
- Ability to work effectively as a member of a team
- Experience with electronic medical records[GK1]
PreEmployment Drug Screening:As a condition of employment Fred Hutch conducts pre-employment drug testing for this pharmacy role. All offers of employment in the pharmacy department are conditional on the applicant successfully completing and passing a drug test in accordance with the Fred Hutch policy.
The hourly pay range for this position is from $35.09 to $52.63 and pay offered will be based on experience and qualifications.
This is a full-time position with a schedule of Monday through Friday, 8:30am to 5:00pm PT. There is also potential for this role to be hybrid or fully remote, depending on business needs and team approval.Although Fred Hutch is not sponsoring most H-1B visas at this time, candidates who already hold an H-1B sponsored by another organization and are currently in the U.S. may be eligible for this position.Fred Hutchinson Cancer Center offers employees a comprehensive benefits package designed to enhance health, well-being, and financial security. Benefits include medical/vision, dental, flexible spending accounts, life, disability, retirement, family life support, employee assistance program, onsite health clinic, tuition reimbursement, paid vacation (12-22 days per year), paid sick leave (12-25 days per year), paid holidays (13 days per year), paid parental leave (up to 4 weeks).
