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Job Details

Rx Prior Authorization Specialist

Requisition #: 184723
Location: Johns Hopkins Home Care Group, Baltimore, MD 21201
Category: Finance
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: April 1, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

Under direct supervision of the Prior Authorization Supervisor, incumbent interacts with hospital employees on multiple levels, including pharmacists, medical/clinical staff, fiscal personnel, department managers, access services staff, coding staff and billing assistants. External contacts include multiple third party payers, prescription benefit management companies, governmental peer review organizations, and referring physicians. The relationships are inherent to the success of this position. This position is primarily responsible for receiving prescriptions specifically related to specialty medications for various disease states, addressing and rectifying rejected claims, conducting and completing necessary third party (insurance) specialty prior authorization requests, and verifies prescriptions to other non-Hopkins entities in instances where the prescription is not filled by Johns Hopkins Outpatient Pharmacy, including routing to Johns Hopkins entities. The level of responsibility is critical, nature of work is complex. The incumbent must possess enhanced knowledge, be the subject matter expert of dispensary specialty drugs, and understand relative disease states. The Pharmacy Prior Authorization Specialist works autonomously and proficiently, and provides leadership skills necessary to guide the insurance company to understand the disease state at times are necessity. The Pharmacy Prior Authorization Specialist also participates in other duties related to the day-to-day operations within the reimbursement department.

Requirements

Education: High School Diploma or Equivalency

Required Licensure: Registration with the Maryland Board of Pharmacy

Experience:

  • One (1) year retail pharmacy technician experience preferred.
  • One (1) year in health care related billing and/or retail pharmacy required, three (3) years preferred.

Knowledge:

  • Of pharmacy work routines, procedures, materials and/or equivalent, mathematics, and terminology (i.e., brand and generic drug names).
  • Of specialty drugs and related disease states.
  • Of and ability to use computers and a variety of computer programs including word processing, entry of prescriptions, database management, and hospital systems.
  • Of third party plans and how they are processed.
  • Of Medication reimbursement, including the prior authorization process.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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