Pharmacy Authorization Specialist (HCPSCQCT)

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. If you enjoy problem solving in a fast-paced team-oriented environment this may be the opportunity for you!

All HCA employees will apply an equity lens to their work which may include but is not limited to all analyses of core business and processes.

About the program:

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. The Prescription Drug Program vision is to provide access to affordable evidence-based medication by designing and delivering high quality evidence- based pharmacy programs through collaborative and innovative prescription drug purchasing strategies. Our goal is to empower each other to provide exceptional services to our customers.

About the position:

This position is responsible for resolving pharmacy prior authorization access issues and ensuring equity across the Medicaid populations. They independently evaluate clinical criteria and use it to design develop implement and monitor prior authorization programs. The Pharmacy Authorization Specialist develops oversees monitors evaluates and administers clinical initiatives within the Outpatient Prescription Drug Program including oversight and review of work performed by other divisions for the implementation of WAC promulgation of policy and enforcement of policy through Pharmacy Point of Sale authorization processing rules.

This position is eligible to telework and is typically not required to report on-site.The default assigned work location of all Health Care Authority (HCA) positions both on-site and telework eligible positions is within the State of Washington. This position reports to Olympia WA. Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework.

Some of what you will do:

• Ensures timely review of authorization requests for prescription drugs and identifies opportunities to increase 1stlevel review by authorization staff.
• Ensures timely resolution of access issues related to prescription drug authorizations. This includes tracking monitoring and resolving authorization issues across all Apple Health Managed Care and fee-for-service (FFS) pharmacy programs.
• 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.
• Researches and resolves pharmacy claim processing system issues relating to pharmacy authorizations. This includes performing system testing to investigate identify and resolve processing errors.
• Performs regular QC/QA of Pharmacy Authorization work to determine accuracy of the application of clinical policy.
• Coordinate implementation of clinical policies new prior authorization initiatives and updates to the Apple Health Preferred Drug List (AHPDL).
• Designs develops monitors and analyzes drug authorization determination reports.

Required qualifications:

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 HCAs ProviderOne MMIS system or comparable medical claim management system.

Qualifying candidates will alsosatisfy one of the following criteria options:

Option 1:

• Masters degree with major study in public health public administration social work or closely related field and
• Two (2) years of supervisory or consultative experience in health services social services or Medicaid programs.

Option 2:

• Bachelors degree with major study in public health public administration social work or closely related field and
• Four (4) years of supervisory or consultative experience in health services social services or Medicaid programs.

Option 3:

• Associate degree with major study in public health public administration social work or closely related field and
• Six (6) years of supervisory or consultative experience in health services social services or Medicaid programs.

Option 4:

• Eight (8) years of supervisory or consultative experience in health services social services or Medicaid programs.

Option 5:

• One (1) year as a Health Care Program Consultant in state service.

Preferred qualifications:

• Knowledge of pharmacy industry and prescription drug terminology;
• Knowledge of and experience with current NCPDP transactional standards;
• Knowledge of and experience with Excel Word and Decision Support applications;
• Knowledge of Federal and state laws and regulations related to Medicaid and health care with particular emphasis in the optional provision of pharmacy benefits within Medicaid according to section 1927 of the SSA;
• Knowledge of continuous quality improvement practices;
• Knowledge of methods of practice of research analysis and report writing at an independent level.

How to apply:

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile which includes three professional references and attach in separate files:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy) NGB 22 or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in .

About HCA:

Functioning as both the states largest health care purchaser and its behavioral health authority the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars HCA purchases health care including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention crisis and recovery supports to all Washington residents.

What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCAs Mission Vision & Values
• A healthy work/life balance including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA State Government Benefits
• A safe pleasant workplace in a convenient location with restaurants and shopping nearby.
• And free parking!

Notes:

Prior to a new hire a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected included and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary employee-led groups whose aim is to foster a diverse inclusive workplace aligned with HCAs mission.Our diversity and inclusion efforts include embracing different cultures backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women racial and ethnic minorities and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age disabled and Vietnam era veterans as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them please contact us at . Persons with disabilities needing assistance in the application process or those needing this job announcement in an alternative format may contact Jake Nelko at or 360.725.0945.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify is a registered trademark of the U.S. Department of Homeland Security.

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