Top 10 Prior authorization pharmacist Jobs in Cincinnati, Oh

Pharmacy Order Entry
Skilled Care Pharmacy —Mason, OH
- Mid-level
- Associate's degree
- Medical terminology
Verification Pharmacist - FuzeRx
Fuze Health —Sharonville, OH
- $61 - $64 an hour
- Full-time
- Hybrid work
- Bachelor of Science
- HIPAA
- Mid-level
- Commuter assistance
- Paid parental leave
Pharmacist Supervisor, Sharonville (2nd Shift) - FuzeRx
Fuze Health —Sharonville, OH
- $135,000 - $145,000 a year
- Full-time
- Mid-level
- Supervising experience
- Continuous improvement
- Commuter assistance
- Paid parental leave
Pharmacy Tech Certified - Outpatient
St. Elizabeth Healthcare —Edgewood, KY
- Mid-level
- Outpatient experience
- High school diploma or GED
- Health insurance
- Tuition reimbursement
Pharmacy Tech Certified Opt
St. Elizabeth Healthcare —Edgewood, KY
- Full-time
- Mid-level
- Outpatient experience
- High school diploma or GED
- Health insurance
- Tuition reimbursement

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Medical Scribe
Oak Street Health —Dayton, OH
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
$17.00 - $28.46 an hour
8d

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Clinical Pharmacist
KabaFusion —Columbus, OH
Currently licensed as a registered pharmacist in state of employment. General knowledge of modern office procedures, filing, telephone techniques and office…
Quick Apply
9d
Staff Pharmacist
Vernovis, Ltd. —Mount Vernon, OH
Operate the point of sale system, including credit card, personal check, cash payments or A/R accounts. Graduate of an accredited college / university of…
$48.13 - $60.00 an hour
Quick Apply

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prior authorization pharmacist jobs near cincinnati, oh

Pharmacy Order Entry

Skilled Care Pharmacy -
Mason, OH

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Job Details

Qualifications

Customer communication
Medicare
Spreadsheets
Word embeddings
Medicaid health insurance
Medicare regulations
Desktop applications
Registered Pharmacy Technician
Medicaid regulations
Medicaid
Productivity software
Medical terminology

Full Job Description

QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/ or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Educational/Work Experience

Associate degree in health related field or 2-5 years direct work experience in health related field
Understanding of Medicare/Medicaid/Insurance Pay types, medical terminology, and brand/generic medications required
Intermediate knowledge of Microsoft Word and Excel, or like applications

Other Qualifications

State of Ohio Pharmacy Technician Registration
Ability to exhibit strong oral and written customer service skills
Ability to effectively interact with all levels of department representatives both internally and externally
Ability to interpret and understand prescription directions
Ability to multitask and adhere to timelines

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Prescription processing (55%)
- Data Entry of new and refill orders which includes:
  - Interprets prescription directions and communicates clarification to the facility as needed.
  - Identifies orders that can not be processed due to coverage issues, missing information, or inability to read/understand
  - Inputs medication orders with correct medication and frequency.
  - Ensures formulary substitutions are made appropriately based on facility contracts
  - Completes appropriate paperwork/forms, as well as communicates order exceptions and any other discrepancies to facilities and team leaders
  - Transmits all third party and Medicaid online claims at time of order entry to ensure payment.
  - Maintains an understanding of the special requirements for each payer including Medicare/Managed Care/Medicaid Formulary and Non-Formulary/Third Party Insurance as well as communicates discrepancies to facilities regarding:
    - Formularies
    - Rejections
    - Contract requirements
    - Exclusions and Non-covered medications
  - Adheres to special Facility processing requirements (i.e. House Stock, Non-covered Medication Policies)
  - Updates patient room number if received on a telephone order
  - Changes profile doctor when notified on a telephone order

Admissions (15%)
- Process new/ readmission information for residents:

Obtains complete resident face sheet from facility and enters all data.
- Prevents duplication of account by conducting Universal Search for patient in Pharmacy System

Enter per diem date if required.

Obtains and inputs correct admissions history and appropriate transfers/ discharges information

Shared responsibility with the billing department in resolving Mason returned mail

Researches and responds to email tree on any problem admissions

Checks under “payment plans” (Frameworks “E1”) to see if patient has Part D insurance

Obtains, verifies and enters appropriate pay source information by next business day

Enters Hospice formulary, if provided upon admission, as well as listing diagnosis

Adds physicians to Pharmacy Information System

Responsible for adding patient face sheet information for a facility start-up

Responsible for placing expired patients on “bed hold” when notified by facility on telephone order

Third Party Submission/Rejections (15%)
- Process all insurance claims at time of order entry
  - Processes all Mason online billing rejections daily; resolves all rejections within 48 hours.
  - When applicable, completes and distributes prior authorizations according to facility contract
  - Acquires and maintains appropriate logs of prior authorizations for follow up
  - Investigates and resolves insurance inquires
  - Communicates to pharmacists any suggested covered alternative recommended by 3rd party payor.
  - Resolves cycle fill rejections

Customer Relations (10%)

Acknowledges and responds to all daily emails and phone calls received prior to one hour of the end of employee’s shift on same business day.

Other Duties (5%)

Acts as back up for Triage Department as needed
Attends training as provided for self-improvement and quality of work
Accepts other duties as assigned

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prior authorization pharmacist jobs in cincinnati, oh

Pharmacy Order Entry

Verification Pharmacist - FuzeRx

Pharmacist Supervisor, Sharonville (2nd Shift) - FuzeRx

Pharmacy Tech Certified - Outpatient

Pharmacy Tech Certified Opt

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