Job Title: Medication Authorization Specialist
Department:   SCHI Brighton                  
Location: 1445 Portland Avenue, Rochester, NY 14621                      
Hours Per Week: 40
Schedule:  Monday - Friday 8:00AM - 4:30PM                       
            

SUMMARY:
This role helps patients’ access necessary medications by navigating insurance and financial support options while fostering clear communication across the care team.

 

RESPONSIBILITIES:

Coordinate and submit prior authorization requests for cardiology medications, and monitor approvals, step therapy requirements, and appeals to ensure timely access to treatment.Collaborate with providers to gather clinical documentation and assist patients with enrollment in pharmaceutical assistance programs, grants, and co-pay support.Maintain current knowledge of manufacturer programs, eligibility criteria, and track patient enrollment and renewal timelines for financial assistance.Contact patients to explain insurance coverage decisions, out-of-pocket responsibilities, and available financial options with empathy and clarity.Accurately document all actions and communications in the Electronic Health Record (EHR), serving as a key resource for patients navigating medication access.Work closely with the care team to improve access workflows and participate in ongoing process improvement initiatives that enhance the patient experience.

REQUIRED QUALIFICATIONS:

2 years work experience in a healthcare settings, medical billing, pharmacy, or insurance verification.
 

PREFERRED QUALIFICATIONS:

Associates Degree in healthcare administration or business preferred.Experience with prior authorizations, pharmacy or specialty medications preferred. Proficiency in electronic medical records (EMR) systems and Microsoft Office applications.Excellent communication skills including both oral and written as well as interpersonal skills.Ability to handle simultaneous tasks paying great attention to detail.Flexibility and ability to work as a team player.Understanding of managed care, formularies, and payer policies. Experience with Electronic Health Records (EHR) systems.

EDUCATION:

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$18.00 - $24.00

CITY:

Rochester

POSTAL CODE:

14621

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer.
Minority/Female/Disability/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.