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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in obtaining prior authorizations and conducting benefit investigations for medications, while effectively communicating with care teams and educating patients on specialty services. Proficient in managing patient assistance programs and ensuring compliance with organizational policies.
Highest-signal resume keywords
Prior Authorization ManagementBenefit InvestigationPatient Assistance ProgramsPharmacy Reimbursement MethodologiesCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prior AuthorizationBenefit InvestigationMedication Assistance ProgramsPharmacy Reimbursement MethodologiesThird-Party Payer AuthorizationEnrollment Paperwork CompletionFund TrackingResearch SkillsDocumentation SkillsEligibility Requirements Knowledge
Soft Skills
CommunicationEducationCollaborationAdaptabilityProblem-Solving
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
Patient CareSpecialty PharmacyInsurance LiaisonAuthorization CriteriaOrganizational Compliance
About the role
Key responsibilities & impact- Obtain prior authorization for medications
- Complete benefit investigations to determine coverage for prescribed treatments
- Serve as liaison for medication prior authorization matters involving insurance companies, departments, and patients
- Act as subject matter expert for patient medication assistance foundations, free drug programs, and drug replacement programs
- Complete prior authorizations and document referrals using appropriate third-party payer criteria
- Conduct research and follow-up activities within established timeframes
- Communicate authorization status and assistance application status to care teams
- Identify appropriate medication assistance programs based on treatment affordability
- Ensure accurate completion of enrollment paperwork and necessary signatures
- Track fund award end dates and exhaustion and re-apply as necessary to avoid therapy lapses
- Educate providers and patients on specialty services and their impact on patient care
- Grow the specialty pharmacy’s patient population
- Float from low-workload areas to high-workload areas as needed to provide patient services
- Satisfy job-specific obligations and comply with organizational policies and procedures
Requirements
What you’ll need- High School Diploma or Equivalent (GED) (Required)
- Minimum of 2 years of related work experience (Required)
- Knowledge of pharmacy reimbursement methodologies
- Knowledge of third-party payer authorization requirements and criteria changes
- Knowledge of patient assistance programs and eligibility requirements
- Ability to complete prior authorizations and benefit investigations
- Ability to research and follow up within established timeframes
- Ability to communicate authorization and assistance application status to care teams
- Ability to complete paperwork and obtain necessary signatures accurately
- Ability to track fund award end dates and exhaustion and re-apply as necessary
- Ability to educate providers and patients on specialty services
- Ability to comply with organization policies and procedures
Benefits
Comp & perks- Healthcare benefits for full-time and part-time positions from day one
- Vision coverage
- Dental coverage
- Domestic partner benefits
- Collaborative, cooperative, and collegial work atmosphere