Building Location:Essentia Health Superior Belknap Pharmacy

Department:1008850 PRIOR AUTHORIZATION - EH SS

Job Description:Medication Access Associates work cross-functionally to ensure that patients are receiving the medication therapy they need to achieve optimal care. Primary responsibility will be to facilitate medication prior authorizations via patients’ pharmacy benefits, assist in Medicare Part B billing and processing, and support patient enrollment in financial assistance programs.

Education Qualifications:

Key Responsibilities:

Gather necessary insurance information to conduct benefits investigation on prior authorization (PA) requests via a patient’s pharmacy benefits Interpret PA and appeal requirements and gather all relevant clinical and supporting documentation for submission to third party payorsEffectively communicate with providers, nursing staff, pharmacies, third parties, and software vendor to work through claims adjudication and processing issues to ensure payment from third party payers for medications ordered by Essentia providers requiring prior authorization Understand Medicare Part B DME billing for Essentia retail pharmacies to help ensure Medicare rules are followed when processing Medicare B billed claimsProvide direct patient interaction in assisting patient with manufacturer-based Patient Assistance Programs (PAP), serving as a liaison between patients, providers, and pharmaceutical manufacturers

Required Qualifications:

1 year experience as a pharmacy technician, medical assistant, claims representative in a managed care role or in a coding role

Preferred Qualifications:

Excellent verbal and written communication skillsAttention to detail and ability to manage multiple tasks simultaneously2 years’ experience as a pharmacy technician, medical assistant, claims representative in a managed care role or in a coding role

Licensure/Certification Qualifications:Licensure/Certifications not required

FTE:0.8

Possible Remote/Hybrid Option:

Remote

Shift Rotation:Day Rotation (United States of America)

Shift Start Time:0800

Shift End Time:1630

Weekends:

Holidays:No

Call Obligation:No

Union:

Union Posting Deadline:

Compensation Range:

$21.49 - $32.24

Employee Benefits at Essentia Health:

At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.