Providence St. Joseph Health

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Job Information

Swedish Health Services Medication Prior Authorization Specialist in Seattle, Washington

Description:

Swedish Medical Group is looking for a Medication Prior Authorization Specialist (1.0 FTE, Day Shift) to work in Swedish Centralized Services at Swedish Medical Group in Seattle, WA.

The Medication Prior Authorization Specialist will facilitate processing of medication prior authorizations for clinic patients in accordance with established guidelines. This position serves as a liaison between physicians, pharmacies, clinic staff and insurance carriers to assure high quality service to Swedish patients and clinics.

In this position you will:

  • Proficient in the principle duties or functions of one or more core medication prior authorization functional areas including prior authorizations, appeals, and audit/training.

  • Acts as a resource and contact for the Prior Authorization Service and provides technical assistance to the clinic staff and/or physicians on patient's coverage, authorization guidelines and procedures, claims research, and department operating procedures.

  • Uses and understands different insurance company websites. Able to navigate the websites and obtain medication prior authorization protocols for each company.

  • Receives and appropriately triages phone calls from pharmacies and clinics needing assistance.

  • Processes all paperwork/forms related to medication prior authorizations, including electronic distribution (fax, web-site applications, and/or telephone).

  • Verifies member eligibility as required to process medication prior authorizations and works with clinic staff and pharmacies as necessary to obtain required information.

  • Reviews patient chart to obtain documentation supporting medical necessity of requested medications. Inserts relevant clinical information on prior authorization form and includes benefit information (i.e., Line-Finder, stated Limitations/Exclusions for patient's plan) pertinent to the medical review process.

  • Contacts clinic to obtain clinical information (chart notes, diagnostic results) as needed to assist in medical review process.

Qualifications:

Required qualifications for this position include:

  • High School diploma or GED

  • Current state registration, license, or certification as appropriate for MA or MA-C required upon hire

  • Three (3) years in a medical clinic or managed care/health insurance plan within the past three (3) years

Preferred qualifications for this position include:

  • Bachelor's Degree in a related field

  • Three (3) years experience in an area such as prior authorizations, medical audits, appeals or delegation

  • CMA or MA with clinical experience working in clinic setting

  • Epic software experience

About Swedish Medical Group

Swedish Medical Group (SMG) is a successful, performance-driven division of Swedish Health Services, the largest non-profit health provider in the Greater Seattle area. The SMG network includes more than 900 providers across 108 primary care and specialty care clinics.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://swedish.jobs/why-swedish/#benefits-rewards

Our Mission

Our Mission is to improve the health and well-being of each person we serve.

Our Vision is Health for a Better World.

About Us

Swedish is the largest not-for-profit health care system in the greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); emergency rooms and specialty center in Redmond (East King County) and the Mill Creek area in Everett; and Swedish Medical Group, a network of more than 128 primary care and specialty care locations throughout the greater Puget Sound area. Swedish employs nearly 13,000 caregivers (all employees), including nearly 1,400 providers. Whether through physician clinics, education, research and innovation or other outreach, we're committed to caring for the people in our region and beyond. Swedish is proud to be an Equal Opportunity Employer Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Administrative (Clinical)

Location: Washington-Seattle

Work Locations: Bank Of America Bldg (WA239) 800 Fifth Ave Seattle, 98104

Req ID: 298105

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