Pharmacy Authorization Specialist (HCPS/CQCT)

This position works to resolve issues that arise for Apple Health clients attempting to access prescribed medication. This specialist uses adept critical thinking skills to determine the issue and work towards a resolution, including interpreting rejection codes, understanding how claims for drugs are billed, and communicating with stakeholders including clients and providers.

• Ensures timely review of authorization requests for prescription drugs and identifies opportunities to increase 1st-level review by authorization staff.
• Ensures timely resolution of access issues related to prescription drug authorizations.
• Communicates resolution to impacted providers and clients.
• Provides oral and written guidance to the Pharmacy Authorization unit in response to policy questions.
• Creates, updates, and reviews documents used by the Pharmacy Authorization unit.

• Qualifying candidates will have two (2) years of claims processing, billing, authorization, or analysis in an NCPDP compliant Pharmacy Point of Service claims processing system, HCA’s ProviderOne MMIS system, or comparable medical claim management system.

• Health insurance
• 401k matching
• Tuition reimbursement
• Free parking

The mission of the Prescription Drug Program within the Health Care Authority is to provide high quality health care through innovative health policies and purchasing strategies.