Pharmacy Prior Authorization Agent

Remote position. Monday-Friday 8am-4:30pm or 8:30am-5pm CST.

• →​​​​​​​Complete insurance verification and eligibility checks. 
• →Collect and accurately document initial pre-certification/authorization information if available. Initiates the process of obtaining a required referral/authorization if not obtained. 
• →Work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue. 
• →Proactively communicate issues involving customer service and process improvement opportunities to management. 
• →Maintains excellent public relations with patients, patients’ families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. 
• →Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans. 
• →Update the patient, physician's office, and any necessary parties, through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of the prior authorizations. 
• →Act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed. 
• →May identify and assist patients with access to internal and external financial assistance programs. 
• →May communicate to the patient and/or physician's office when authorization is not obtained, or services are not covered, and explains the potential financial responsibility. Coordinates with patient, clinical team, and assistance programs to secure reimbursement or alternative covered options. 
• →Manages incoming and outgoing calls, which may include other Advocate team members, departments, patients, insurance plans and/or copay foundation/assistance programs. 

• ​​​​​None Required 

• ​​​​​​​​​High School Graduate 

• ​​Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background  

• Demonstrate ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available 
• Ability to problem solve in a high profile and high stress area 
• Mathematical aptitude, effective communication, and critical thinking skills 
• Ability to prioritize and organize workload 
• Excellent Verbal and written communication skills 
• Demonstrated technical proficiency including experience with insurance authorization/eligibility tools, EPIC, Microsoft Office, Internet browser and telephony systems 

• ​​​​​​​​​Operates all equipment necessary to perform the job 
• Exposed to normal office environment areas, or remote work area 
• Must have the ability to lift to 10 lbs. occasionally 
• Uses a computer continuously throughout the workday 
• Must be able to sit for extended periods of time  ​  

• No additional education is required 

• No additional experience necessary 

• Knowledge of medical terminology 

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.        

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.