Phamacy Prior Authorization and Benefit Assistant I Job

Bloomington, MN, 55420
Apr 05, 2012
Apr 30, 2012
Employment Status
Full Time
Phamacy Prior Authorization and Benefit Assistant I

Job ID:: 23223
Department:: Health Plan Pharmacy Admin
City:: Bloomington, MN
Location:: HP - Bloomington 8170 Office Bldg
Position Type:: Full-Time
Anticipated Work Schedule:: Monday through Friday 9:30am-6:00pm
Hrs/Pay Period:: 80

Job Description::

The culture at HealthPartners is one of ownership, pride, service, and most importantly, partnership. That spirit of partnership among employees, and with patients and the community is just one of the many reasons we were recently named one of the nation’s “Best Places to Work in Healthcare” by Modern Healthcare magazine. Join us for a career that offers respect, support and encouragement. You’ll stay for the power of partnership.

Our continued growth has created an opportunity for a Phamacy Prior Authorization and Benefit Assistant I to work at the HealthPartners Bloomington Offices. The purpose of this position is to serve as a resource to physicians, members, Member Services staff, pharmacies and department staff with regard to pharmacy benefits, claims, formulary and pharmacy policies and procedures. This position also processes network physician requests for formulary and non-formulary drugs that require prior authorization. Physician and member requests are processed independently by reviewing requests based on pre-determined clinical criteria. This position also reviews and determines appropriate reimbursements/processing of all claims requested from members and providers. Service excellence with patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members.

Monday through Friday 9:30 am – 6:00 pm

• High School diploma or GED
• Two years pharmacy benefit experience at a pharmacy benefit management company including pharmacy claims processing knowledge OR Two years Pharmacy Technician experience at a community pharmacy that includes billing of pharmacy claims
• Broad knowledge of drugs and drug categories
• Broad knowledge of pharmacy benefits
• Demonstrated independent analytic problem solving skills
• Excellent written and oral communication skills
• Automated pharmacy claims processing experience
• Ability to work independently in a fast-paced environment
• Exceptional customer service skills
• Ability to maintain productive working relationships with team members and other internal and external customers

• Data entry - 4,000 keystrokes

Pharmacy Benefits Customer Service

1. Provide excellent customer service to physicians, members, member services staff, other internal staff, and pharmacies regarding pharmacy benefits and claims, formulary, and pharmacy policy and procedures for all HealthPartners products (Fully Insured, Self Insured, Medicare, and Medicaid). Focus on ownership and first call resolution. Evaluate and redirect calls to appropriate areas or departments.
2. Independently process a high volume of provider requests for non-formulary drugs and prior authorization drugs on HealthPartners formulary based on pre-determined clinical criteria.
3. Organize, retrieve and share data under tight timelines in accordance with National Council Quality Assurance, ERISA, and CMS (Centers for Medicare and Medicaid Services) guidelines to process requests using HIPAA security measures and assist in internal and external audits.
4. Organize and log all information on several databases for reporting purposes.
5. Handle all call center duties with knowledge of department functions, processes and procedures professionally, courteously, and competently.
6. Build rapport with coworkers, internal customers, pharmacies, vendors and members by demonstrating a strong customer service orientation and a continuous positive image of HealthPartners.
7. Determine inconsistencies pertaining to pharmacy benefit and pharmacy adjudication and independently resolve member’s pharmacy issue based on patient care and unique circumstances.
8. Manually load member/group enrollment information, if needed.
9. Independently manage filing system for Prior Authorization department and keep records stored on-site or archived as required by applicable department policy and/or law. Keep all records current.
10. Assist with training personnel.
11. Perform all duties utilizing excellent customer service skills.
12. Perform other duties as required.

Claims Processing

1. Quote group and member pharmacy benefits and resolve inconsistencies pertaining to out of pocket costs, pharmacy adjudication, and formulary management logic.
2. Identify and interpret Explanation of Benefits received from members and other carriers.
3. Meet all established production and quality standards.

HealthPartners is nationally acclaimed for providing outstanding patient care and we offer an excellent salary and benefits package. For more information and to apply go to and search for job ID 23223.


Health is what we do. Partnership is how we do it.

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