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Day - 08 Hour (United States of America)
This is a Stanford Medicine Partners job.
A Brief Overview
The pharmacy medication pre auth coordinator will join a highly integrated, fast paced team that supports the Stanford Medicine Partner Physician Foundation, Stanford Healthcare Enterprise.
The pharmacy medication pre-auth coordinator will support the entire electronic process from submission to processed pharmacy prescribed medication. The coordinator will facilitate the approval of necessary medications to the insurance companies, to ensure patients receive the required medication.
The process may result in authorization, denial or closed status and the coordinator is expected to work through all the steps in a timely manner to prevent delays in patient care. This includes sharing Epic related system issues and opportunities which include but are not limited to optimizing clinical workflows to ensure health plan requirements are met prior to submission. The coordinator will support the needs of the Stanford Medicine Partner Physician Foundation clinics and report directly to the REACT Manager, Centralized Referral Team.
Locations
Stanford Medicine Partners
What you will do
- Pharmacy Medicine Pre-Auth Coordinator:
- Responsible for confidentially reviewing medical records to confirm proper documentation is in the chart to support the pharmacy prescription
- Responsible for submitting detailed chart notes and other pertinent documentation to support the authorization request.
- Manages the EMR workqueue pertaining to pharmacy prescriptions for new request submission and re-submission to the health plans.
- Must be capable of clear communication to all levels: Clinicians, Clinic and Finance Leadership, clinical team members and patients and Pharmacies.
- Communicates effectively with patients, providers and insurance companies regarding authorization status.
- Documentation - maintains accurate records of all interactions and documentation related to authorization requests
- Confirms active insurance is on file. May be responsible to obtain benefits as required or needed.
- Required to confirm if proper pharmacy benefit workflow is intact.
- Responsible for following deferred standard workflow to avoid patient care delays.
- Collaborate with area Lead and Manager to streamline processes.
- Communication Procedures:
- Communicates with use of created smartphrases for consistent messaging and/or messages in a courteous and professional manner in accordance with performance standards.
- Coordinates and Communicates with Clinics, Patients, Pharmacists and Health Plans.
- Electronic Health Record Documentation:
- Accesses EHR to communicate to clinical staff members and/or physicians through referral in-basket message, pools or telephone encounters using SBAR format and/or appropriate smart phrases in accordance with performance standards.
- Manages EHR in-basket(s), referral work queues in accordance with performance standards.
- All other duties as assigned including department-specific functions and responsibilities:
- Performs other duties as assigned and participates in organization projects as assigned.
- Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.
Provides orientation and training to new staff as assigned.
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Education Qualifications
High school graduate or equivalent.
Experience Qualifications
- Two (2) - four (4) years of similar experience pertaining to pharmacy prescriptions that require pre-authorization in a physician office-based setting.
- Ability to type a minimum of 30 wpm.
Experience in healthcare or related setting preferred.
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Required Knowledge, Skills and Abilities
- Strong verbal/written communication and listening skills; including excellent interpersonal skills and telephone communication.
- Legible handwriting.
- Ability to maintain composure during challenging interpersonal interactions.
- Basic math skills necessary to collect payments and balance cash drawer.
- Basic computer skills to include keyboarding, mouse movement and data entry skills to enter information into practice management system and EHR.
- Ability to effectively organize and prioritize tasks in order to complete assignments within the time allotted and maintain standard workflow.
Ability to work with others in a flexible, cooperative manner.
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Physical Demands and Work Conditions
Physical Demands
- Constant Sitting.
- Frequent Walking.
- Occasional Standing.
- Occasional Bending.
- Occasional Squatting.
- Occasional Climbing.
- Occasional Kneeling.
- Seldom Crawling.
- Constant Hand Use.
- Constant Repetitive Motion Hand Use.
- Frequent Grasping.
- Occasional Fine Manipulation.
- Frequent Pushing and Pulling.
- Occasional Reaching (above shoulder level).
- Frequent Twisting and Turning (Neck and Waist).
- Constant Vision (Color, Peripheral, Distance, Focus).
Lifting
- Frequent lifting of 0 - 10 lbs.
- Occasional lifting of 11 - 20 lbs.
- Seldom lifting of 21 - 30 lbs.
- Seldom lifting of 31 - 40 lbs.
- Seldom lifting of 40+ lbs.
Carrying
- Frequent lifting of 0 - 10 lbs.
- Occasional lifting of 11 - 20 lbs.
- Seldom lifting of 21 - 30 lbs.
- Seldom lifting of 31 - 40 lbs.
- Seldom lifting of 40+ lbs.
Working Environment
- Occasional Driving cars, trucks, forklifts and other equipment. May be required to drive personal vehicle to sites.
- Constant Working around equipment and machinery. Office equipment (computers, phones, fax, copy machines, printers, 10-key, etc.).
- Seldom Walking on uneven ground.
- Seldom Exposure to excessive noise.
- Seldom Exposure to extremes in temperature, humidity or wetness.
- Seldom Exposure to dust, gas, fumes or chemicals.
- Seldom Working at heights.
- Seldom Operation of foot controls or repetitive foot movement.
- Seldom Use of special visual or auditory protective equipment.
- Seldom Use of respirator.
- Seldom Working with biohazards such as blood borne pathogens, hospital waste, etc..
- Seldom Other (please list each item under Comments):.
Blood Borne Pathogens
- Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment
Travel Requirements
10% travel:
These principles apply to ALL employees:
Commitment to Providing an Exceptional Patient & Family Experience
University HealthCare Alliance dba Stanford Medicine Partners sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
- Know Me: Anticipate my needs and status to deliver effective care
- Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
- Coordinate for Me: Own the complexity of my care through coordination
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $29.56 - $37.69 per hour
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
