Medication Access Associate - Prior Authorization

Building Location:

Essentia Health Superior Belknap Pharmacy

Department:

1008850 PRIOR AUTHORIZATION - EH SS

Job Description:

Medication Access Associates work cross-functionally to ensure that patients are receiving the medication therapy they need to achieve optimal care. Primary responsibility will be to facilitate medication prior authorizations via patients’ pharmacy benefits, facilitate authorization of patient prescription refill requests, assist in Medicare Part B billing and processing, and support patient enrollment in financial assistance programs.

Education Qualifications:

Key Responsibilities:

• Follow policy and procedures to determine eligibility for prescription refill authorization
• Gather necessary insurance information to conduct benefits investigation on prior authorization (PA) requests via a patient’s pharmacy benefits
• Interpret PA and appeal requirements and gather all relevant clinical and supporting documentation for submission to third-party payors
• Effectively communicate with fellow team members, providers, nursing staff, pharmacies, third parties, and software vendors to work through claims adjudication and processing issues to ensure payment from third-party payers for medications ordered by Essentia providers requiring prior authorization
• Understand Medicare Part B DME billing for Essentia retail pharmacies to help ensure Medicare rules are followed when processing Medicare B billed claims
• Provide direct patient interaction by assisting patients with manufacturer-based patient assistance programs (PAP) and liaising between patients, providers, and pharmaceutical manufacturers
• Other duties as assigned

Required Qualifications:

• 1 year experience as a pharmacy technician, medical assistant, claims representative in a managed care role or in a coding role
• Excellent verbal and written communication skills
• Attention to detail and ability to manage multiple tasks simultaneously
• Licensed/Certified in field of experience (CPhT, CMA, etc.)

Preferred Qualifications:

• 2 years’ experience as a pharmacy technician, medical assistant, claims representative in a managed care role or in a coding role

Licensure/Certification Qualifications:

Certification/Licensure Requirements:

• Licensed/Certified in field of experience (CPhT, CMA, etc.)

FTE:

1

Possible Remote/Hybrid Option:

Remote

Shift Rotation:

Day Rotation (United States of America)

Shift Start Time:

Shift End Time:

Weekends:

Holidays:

No

Call Obligation:

No

Union:

Union Posting Deadline:

Compensation Range:

$21.49 - $32.24

Employee Benefits at Essentia Health:

At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.