Specialty Pharmacy Prior Authorization (call center/support tech)

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Responsible for precertification of eligible prescriptions. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence. A Brief Overview Responsible for precertification of eligible prescriptions. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services.

Models appropriate behavior as exemplified in MLH Mission, Vision and Values. What you will do Responsible for precertification of eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity. Ensures medical documentation is sufficient to meet insurer guidelines for medical necessity documentation and procedure payment.

Reviews clinical information submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of prescription medications. Assists with patient assistance and grant coordination for Patients for outpatient pharmacies from designated areas. Proactively analyzes information submitted by providers to make timely medical necessity review determinations based on appropriate criteria and standards guidelines.

Verifies physician orders are accurate. Determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.