Pharmacy-Prior Authorization

Dupage Medical Group Tinley Park , IL 60477

Posted 3 weeks ago

Hours: Monday-Friday, 8:30am-5:00pm

Location: Lisle, Tinley Park


The Health Plan Services Pharmacy Prior Authorization Tech supports designated DMG provider sites in obtaining pharmacy prior authorizations for their members in need of medications that are identified by the respective health plan as needing prior authorization and review as well as requests originating from pharmacies. Accountable for processing medication requests with the patient's health plan or pharmacy carrier.


  • Data Collection and Documentation

  • Receives and documents, telephonic, and/or electronic requests for medications that require prior authorizations -- source of request is from Primary Care Physicians, Specialists and Ancillary providers

  • Verifies member eligibility and basic benefit coverage levels including obtaining information on coordination of benefits and third party liability as appropriate

  • Utilizes computer resources and available resources both internal and external, to determine provider networks

  • Evaluates each Prior Authorization request to ensure the request including codes, place of service, service type, provider, and all required medical information is available for submission to insurance carrier or approving entity

  • Investigates and obtains from providers, missing medical information required for Prior Authorization submission

  • Maintains accurate and appropriate documentation and follows patient privacy in accordance with HIPPA and DMG policies and procedures

  • Interface with Health Plans and Provider offices

  • Contacts physician offices, pharmacies, review organizations and insurance companies to obtain prior approval requirements, and submit appropriate forms and clinical documentation

  • Works with physician offices to provide ongoing education regarding prior authorization process and requirements

  • Maintains a current working knowledge of all health plan carrier requirements as it relates to requests for prior authorizations and approval path requirements (pre-determinations and peer to peers)

  • Applies clinical knowledge and application of health plan formularies, ICD-9 and CPT coding, as well as medical terminology for appropriate communication with physicians and providers

  • Functions as a resource to physician/provider offices regarding prior authorization requirements, networks, and alternate medication availability as recommended by the patients' health plan

  • Provides source of prior approval request with timely notification of approval or denial decisions through designated communication routes

  • System enter and other functions

  • Performs data entry/processing of prior authorization requests through the EPIC system, and edits Prior authorization notes with appropriate information as outlined per department guidelines and procedures

  • Maintains accurate and detailed prior authorization notes and patient chart documentation entries

  • Resources Team Lead or Supervisor/Manager for review of complex requests and issues

  • Provides input to Team Lead and Supervisor/Manager regarding improvements to operating practices

  • Assists with orientation and training of new staff


Level of Education

  • HS Diploma required

  • Associates Degree strongly preferred

Years of Experience

  • 2-3 years of pharmacy technician or medical assistant experience preferred
  • 2+ years pharmacy or health insurance office experience strongly preferred


  • Medications, generic substitutions/alternatives, office ordering practices regarding medication lab requirements and refills knowledge required

  • Epic system preferred or familiar with other EMR/EHR systems required

  • Understanding of the medical insurance industry and health plans required

  • Proficient computer navigation skills, with advanced Microsoft Office/Outlook and intra/internet experience required

  • Medical Terminology Knowledge required

  • Effective communication skills required


Join one of the fastest-growing healthcare teams in Chicagoland and experience what superior care and innovation is all about. DuPage Medical Group is the largest independent, multi-specialty physician group in the state, providing physician-directed healthcare focused on quality, efficiency and access. Our team is comprised of more than 700 experienced physicians and 5,500 dynamic individuals who work collaboratively to transform healthcare for the thousands of patients we serve each day. We seek candidates who can help fulfill our mission to enhance the well-being of the patients we serve by providing the highest quality medical care available.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Automotive Assistant / Service Managers

Mavis Tire

Posted 1 week ago

VIEW JOBS 10/13/2020 12:00:00 AM 2021-01-11T00:00 Mavis Tires & Brakes at Discount Prices - Automotive Assistant / Service Managers Put your career into high gear with Mavis Tires & Brakes at Discount Prices! We're looking for a full-time Service Manager to join Team Mavis at one or our state-of-the-art automotive service and retail tire sales centers in the Tinley Park, IL area. With over 700 retail locations throughout New York, New Jersey, Connecticut, Massachusetts, Pennsylvania, Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Delaware and Texas Mavis is one of the largest tire sales and automotive repair chains in the United States. About the Position of Assistant Manager The Assistant Manager is responsible for the efficient operation of the repair shop. The individual will be responsible for scheduling mechanics/technicians work, ordering parts, ensuring the quality and timely completion of jobs exceeding customer expectations, the safety of personnel and housekeeping of the shop. Candidates must be, knowledgeable of under-car repairs, alignments, tires and exhaust systems, as well as, possess basic math and pc skills. Communicates safety and mechanical issues to the store manager to relate to the customer. Basic supervisory/leadership skills are also required to be fully effective in the role. About the Position of Service Manager The Service Manager is responsible for assisting customers with tire selections and under-car repair services needed. This is a sales oriented position requiring prior sales experience in products/services requiring up selling techniques. Knowledge of repairs and the automotive industry a plus. Excellent interpersonal skills are required to be successful; as well as, outgoing, personable, and success oriented. Employee Benefits At Mavis, we understand that our people drive our success. We provide our team members with competitive weekly pay, including weekly incentive compensation, a good working environment and an excellent combination of additional benefits like health and dental insurance, a 401(k) retirement savings plan with employer match, paid vacations, paid sick and personal time, on-the-job training, and opportunities for career growth and advancement. Qualifications We recruit team members who share our commitment to providing complete customer satisfaction and delivering the highest quality service. To be eligible for the position of Assistant / Service Manager, you must (1) be at least 18 years of age; (2) be legally authorized to work in the United States; and (3) possess (i) 1 year of experience and/or training in automotive parts and/or tire sales, (ii) 1 year of experience and/or training in automotive repairs/maintenance, or (iii) any combination of education, training and experience which demonstrates the ability to perform the duties and responsibilities of the position. Mavis is an Equal Opportunity Employer Consistent with our commitment to the principal of equal employment opportunity for all individuals, we enforce a zero tolerance policy on discrimination at Mavis. Employment decisions are made without regard to an applicant's or employee's actual or perceived membership in any category or status protected by applicable federal, state or local law. The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of the position. Where appropriate, Mavis may provide reasonable accommodation, in order for an otherwise qualified individual to perform the essential functions of the position. Mavis does not seek salary history information from applicants. #cb Mavis Tire Tinley Park IL

Pharmacy-Prior Authorization

Dupage Medical Group