WVU Medicine
Pharmacy Prior Authorization Specialist
WVU Medicine, Morgantown, West Virginia, United States, 26501
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Position Overview
The Prior Authorization Specialist supports WVUH Clinics by completing prior authorization (PA) requests for medications and ensuring timely, accurate processing to support optimal patient care. This role requires a naturally curious and investigative mindset, strong attention to detail, and complete tasks that demand consistency and accuracy. The ideal candidate is self‑motivated, communicates proactively, and thrives in a structured yet fast‑paced environment with opportunities for growth. Position will be full‑time hybrid position staffing Monday through Friday with no weekends or holidays. Key Responsibilities
Complete medication prior authorizations using payer portals, electronic systems, and direct communication with insurance companies. Investigate insurance coverage criteria, documentation requirements, and medication policies to ensure accurate submissions. Collaborate with WVUH providers, clinic staff, and pharmacists to obtain necessary clinical information. Monitor, track, and follow up on pending authorizations to ensure timely resolution. Maintain organized records of PAs, approvals, denials, and other appropriate documentation. Escalate high‑priority requests or barriers to the appropriate clinical or administrative teams. Communicate workload challenges proactively to supervisors while maintaining a solution‑oriented, go‑getter approach. Adapt to expanding responsibilities as the program grows, including potential involvement in workflow improvements or training. Minimum Qualifications
High school diploma or equivalent. Must possess current licensure as required by state board where services will be provided (MD: Pharmacy Technician License or Student Permit through Maryland Board of Pharmacy; OH: Certified or Registered Pharmacy Technician License or Trainee License through Ohio Board of Pharmacy; PA: No state licenses issued; WV: Pharmacy Technician License or Trainee License through West Virginia Board of Pharmacy). Nationally Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National Healthcareer Association (NHA). OR applicant has two (2) or more years of pharmacy‑specific experience, obtained within 15 months of hire. Preferred Qualifications
Associates degree or post‑high school education in a science field of study or graduate of a pharmacy technician training program. Core Duties and Responsibilities
Draft various correspondence letters and send to referral source when necessary. Gather and document patient demographics, insurance information, needs assessment, patient history, and other data as needed. Initiate refill/follow‑up calls and schedule delivery as needed. Provide information and answers to patient/caregiver questions and refer to clinician when appropriate or requested. Identify all patients requiring pre‑certification or pre‑authorization at the time services are requested or when notified by another hospital or clinic department. Contact insurance company or employer to determine eligibility and benefits for requested services. Maintain patient records in a timely and complete manner. Assist the pharmacist with the process of filling and labeling the prescriptions. Calculate initial measurements for compounds and maintain compounds logs. Provide monographs and other required medication guides with each prescription. Maintain proper storage of medications (i.e. security, temperature controlled items, etc.). Demonstrate the knowledge and skills necessary to communicate to the infant, pediatric, adolescent, adult and/or geriatric patient per the established age‑specific education/standard. Work with coordinators and manager to develop and attain quarterly objectives. Maintain confidentiality according to policy when interacting with patients, physicians, families, co‑workers and the public regarding demographic/clinical/financial information. Communicate problems hindering workflow to management in a timely manner. Assist in the training of pharmacy technicians. Initiate charge anticipation calculations. Accurately identify anticipated charges to assure identification of anticipated self‑pay portions. Physical Requirements
Walk and stand or sit for long periods of time. Must be able to lift 30 pounds and push 50 pounds. Dexterity required to finger, handle, and reach. Working Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities
Must be able to use computers and software applications. Knowledge of drugs, drug dosing, side effects, indications, contraindications and proper administration preferred. Knowledge of rules, policies and regulations related to the disbursal of pharmaceutical drugs preferred. Must be able to work accurately, efficiently, and safely in a fast‑paced environment. Must be polite and respectful when communicating with staff, physicians, patients and families. Must approach interpersonal relations in a positive manner. Must demonstrate flexibility to meet the needs of department or hospital in regard to changes in work volume, planned change, scheduling changes and emergency call‑backs. Must be able to communicate effectively verbally and in writing and place high emphasis on customer service. Additional Job Description
Scheduled Weekly Hours: 40 Shift: United States of America (Non‑Exempt) Company: WVUH West Virginia University Hospitals Address: 1 Medical Center Drive, Morgantown, West Virginia Equal Opportunity Employer
West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
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The Prior Authorization Specialist supports WVUH Clinics by completing prior authorization (PA) requests for medications and ensuring timely, accurate processing to support optimal patient care. This role requires a naturally curious and investigative mindset, strong attention to detail, and complete tasks that demand consistency and accuracy. The ideal candidate is self‑motivated, communicates proactively, and thrives in a structured yet fast‑paced environment with opportunities for growth. Position will be full‑time hybrid position staffing Monday through Friday with no weekends or holidays. Key Responsibilities
Complete medication prior authorizations using payer portals, electronic systems, and direct communication with insurance companies. Investigate insurance coverage criteria, documentation requirements, and medication policies to ensure accurate submissions. Collaborate with WVUH providers, clinic staff, and pharmacists to obtain necessary clinical information. Monitor, track, and follow up on pending authorizations to ensure timely resolution. Maintain organized records of PAs, approvals, denials, and other appropriate documentation. Escalate high‑priority requests or barriers to the appropriate clinical or administrative teams. Communicate workload challenges proactively to supervisors while maintaining a solution‑oriented, go‑getter approach. Adapt to expanding responsibilities as the program grows, including potential involvement in workflow improvements or training. Minimum Qualifications
High school diploma or equivalent. Must possess current licensure as required by state board where services will be provided (MD: Pharmacy Technician License or Student Permit through Maryland Board of Pharmacy; OH: Certified or Registered Pharmacy Technician License or Trainee License through Ohio Board of Pharmacy; PA: No state licenses issued; WV: Pharmacy Technician License or Trainee License through West Virginia Board of Pharmacy). Nationally Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National Healthcareer Association (NHA). OR applicant has two (2) or more years of pharmacy‑specific experience, obtained within 15 months of hire. Preferred Qualifications
Associates degree or post‑high school education in a science field of study or graduate of a pharmacy technician training program. Core Duties and Responsibilities
Draft various correspondence letters and send to referral source when necessary. Gather and document patient demographics, insurance information, needs assessment, patient history, and other data as needed. Initiate refill/follow‑up calls and schedule delivery as needed. Provide information and answers to patient/caregiver questions and refer to clinician when appropriate or requested. Identify all patients requiring pre‑certification or pre‑authorization at the time services are requested or when notified by another hospital or clinic department. Contact insurance company or employer to determine eligibility and benefits for requested services. Maintain patient records in a timely and complete manner. Assist the pharmacist with the process of filling and labeling the prescriptions. Calculate initial measurements for compounds and maintain compounds logs. Provide monographs and other required medication guides with each prescription. Maintain proper storage of medications (i.e. security, temperature controlled items, etc.). Demonstrate the knowledge and skills necessary to communicate to the infant, pediatric, adolescent, adult and/or geriatric patient per the established age‑specific education/standard. Work with coordinators and manager to develop and attain quarterly objectives. Maintain confidentiality according to policy when interacting with patients, physicians, families, co‑workers and the public regarding demographic/clinical/financial information. Communicate problems hindering workflow to management in a timely manner. Assist in the training of pharmacy technicians. Initiate charge anticipation calculations. Accurately identify anticipated charges to assure identification of anticipated self‑pay portions. Physical Requirements
Walk and stand or sit for long periods of time. Must be able to lift 30 pounds and push 50 pounds. Dexterity required to finger, handle, and reach. Working Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities
Must be able to use computers and software applications. Knowledge of drugs, drug dosing, side effects, indications, contraindications and proper administration preferred. Knowledge of rules, policies and regulations related to the disbursal of pharmaceutical drugs preferred. Must be able to work accurately, efficiently, and safely in a fast‑paced environment. Must be polite and respectful when communicating with staff, physicians, patients and families. Must approach interpersonal relations in a positive manner. Must demonstrate flexibility to meet the needs of department or hospital in regard to changes in work volume, planned change, scheduling changes and emergency call‑backs. Must be able to communicate effectively verbally and in writing and place high emphasis on customer service. Additional Job Description
Scheduled Weekly Hours: 40 Shift: United States of America (Non‑Exempt) Company: WVUH West Virginia University Hospitals Address: 1 Medical Center Drive, Morgantown, West Virginia Equal Opportunity Employer
West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
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