Specialist, Pharmacy Authorization

Why Join Our Team? At New York Cancer & Blood Specialists (NYCBS) , we are dedicated to making a difference in the lives of our patients, their families, and our communities. Our passionate team of expert oncologists, hematologists, and healthcare professionals work together to provide world-class cancer care close to home.

By offering cutting-edge treatments, innovative research, and a patient-centered approach, we are redefining what’s possible in the fight against cancer and blood disorders. If you want to be part of a growing organization committed to healing, hope, and advanced care , join us and help make a meaningful impact! Job Description: In This Role, You Will: Run and work daily Business Office Report in OncoEMR for drug order values: POD Verify and NYCBS Pharm Fill for current date of service and one week out to be worked to obtain prior authorizations.

All STAT orders are to be worked immediately upon request by onsite team. Work daily requests from onsite pharmacy dispensaries to obtain prior authorization on requested medication. Document notes in the Sig Box of OncoEMR in the patient’s treatment plan including approval status or in text note where applicable. Must document all steps taken in research/process of the case Prepare appeals for denials on prior authorization requests where applicable.

Refer prescription fill requests that are denied or that have a patient financial responsibility to the pharmacy financial counselor for review. Ensure that all aspects of approval have been checked regarding prior authorization, pre- determination, and pre-certification before approving the order as meeting NYCBS policy.

Verify patient’s own drug with pharmacy related queries where applicable. Notify Nursing Management if orders need to be changed to BB (patient’s own drug) or to Buy/Bill (billing through medical insurance) Work any prior authorization requests from local pharmacies on patient’s oral medications or on specialty pharmacy drugs.

Maintain and ensure the confidentiality of all patient and employee information at all times. A pharmacy authorization specialist will be expected to work when given sufficient notice of required overtime. We Require: High school or GED required. Experience in pharmacy / authorization field. Experience working in the healthcare field, preferably in a clinical setting or business office.

Experience in insurance requirements and medical terminology ICD-10 and CPT coding. Experience in billing practice management systems, electronic medical record systems, Microsoft Word, and Microsoft Excel. Excellent verbal and communication skills between co-workers, physicians, management staff, patients, insurances, outside programs.

Ability to multitask, problem solve, utilize basic math skills and follow complex instructions. Must have ability to converse in a calm and friendly manner. Able to relate and comfort patients during a difficult time.