Job Description

Assists the medical sites with completion of prior authorizations.  Works with providers to prevent lapses in patient medication fills through either prior approval completion or giving them information on what medication is covered.  Will work within Cover My Meds to complete prior approvals.  The duties include:

• Assists medical sites with completion of prior approvals
• Coordinates with the pharmacy to alert staff of approved or denied prior approvals
• Provide appeal/denial information to providers office
• Works prior approvals through Cover My Meds platform
• Navigate electronic health record to pull required information needed to complete prior approval paperwork and obtain pertinent medical information to document prior authorization request
• Interact with appropriate medical and professional staff on a case-by-case basis to obtain appropriate clinical documentation to ensure accurate indications in the patient’s medical record before completion of third party authorizations
• Understand, anticipate, and respond to complex questions from third party payers
• Be proactive in contacting third-party payers and initiate communication to ensure appropriate future payments
• Streamline and centralize third party medications prior authorizations of high-cost injectable medications
• Complies with all 340B program guidelines; maintains current knowledge of program requirements.
• Completes all assignments and signs all documents in Power DMS & Relias in a timely manner.
• Maintains current SC Pharmacy Technician license and pharmacological knowledge by completing continuing education, attending educational workshops, reviewing professional publications, establishing personal networks, and/or participating in professional societies.
• Demonstrates efficiency in all pharmacy computer systems, included but not limited to QS/1 NRX, ECW, and McKesson
• Complies with state and federal drug laws as regulated by the state board of pharmacy and drug enforcement administration. 

Education and Experience

• High school diploma or GED equivalent required.
• License required - Active license by the South Carolina Board of Pharmacy required.
• Two (2) to four (4) year experience in field or related field
• BLS/CPR Certification required(must have been obtained through the American Heart Association or American Red Cross)

Hours

Monday-Friday, 40 Hours, Full Time

Location

Hartsville, SC

CareSouth Carolina is committed to providing equal employment opportunities to all individuals. We welcome and encourage applications from all qualified individuals, without regard to race, color, age, sex, pregnancy, gender identity or expression, sexual orientation, religion, creed, national origin, ancestry, marital status, citizenship, genetic information, disability, military or veteran status, or any other characteristic protected by law.