Specialist, Pharmacy Authorization

Why Join Our Team?

At New York Cancer & Blood Specialists (NYCBS) , we are dedicated to making a difference in the lives of our patients, their families, and our communities. Our passionate team of expert oncologists, hematologists, and healthcare professionals work together to provide world-class cancer care close to home. By offering cutting-edge treatments, innovative research, and a patient-centered approach, we are redefining what’s possible in the fight against cancer and blood disorders.

If you want to be part of a growing organization committed to healing, hope, and advanced care , join us and help make a meaningful impact!

Job Description:

In This Role, You Will:

- Run and work daily Business Office Report in OncoEMR for drug order values: POD Verify and
- NYCBS Pharm Fill for current date of service and one week out to be worked to obtain prior
- authorizations. All STAT orders are to be worked immediately upon request by onsite team.
- Work daily requests from onsite pharmacy dispensaries to obtain prior authorization on
- requested medication.
- Document notes in the Sig Box of OncoEMR in the patient’s treatment plan including approval
- status or in text note where applicable. Must document all steps taken in research/process of the
- case
- Prepare appeals for denials on prior authorization requests where applicable.
- Refer prescription fill requests that are denied or that have a patient financial responsibility to the
- pharmacy financial counselor for review.
- Ensure that all aspects of approval have been checked regarding prior authorization, pre-
- determination, and pre-certification before approving the order as meeting NYCBS policy.
- Verify patient’s own drug with pharmacy related queries where applicable.
- Notify Nursing Management if orders need to be changed to BB (patient’s own drug) or to
- Buy/Bill (billing through medical insurance)
- Work any prior authorization requests from local pharmacies on patient’s oral medications or on
- specialty pharmacy drugs.
- Maintain and ensure the confidentiality of all patient and employee information at all times.
- A pharmacy authorization specialist will be expected to work when given sufficient notice of
- required overtime.

We Require:

- High school or GED required.
- Experience in pharmacy / authorization field.
- Experience working in the healthcare field, preferably in a clinical setting or business office.
- Experience in insurance requirements and medical terminology ICD-10 and CPT coding.
- Experience in billing practice management systems, electronic medical record systems, Microsoft
- Word, and Microsoft Excel.
- Excellent verbal and communication skills between co-workers, physicians, management staff,
- patients, insurances, outside programs.
- Ability to multitask, problem solve, utilize basic math skills and follow complex instructions.
- Must have ability to converse in a calm and friendly manner.
- Able to relate and comfort patients during a difficult time.