Senior Pharmacy Prior Authorization Representative

Job Description:

• Obtain initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies via portal, phone, and fax
• Follow up on initial and renewal authorizations in a timely manner
• Interface with other departments and identify medical documentation supporting prior authorization requests
• Notify patients, prescribers, and internal teams of insurance denials and appeals processes
• Confirm plan eligibility and process test claims
• Calculate required units and quantity versus day supply
• Prioritize and complete assigned tasks on schedule
• Respond to chat and email update requests timely
• Relay problems, concerns, questions, and ideas through appropriate communication lines
• Maintain expected productivity and work effectively
• Meet quality standards and demonstrate reliability and follow-through
• Communicate effectively and express ideas clearly
• Perform in accordance with system-wide competencies and behaviors
• Perform other duties as assigned

Requirements:

• HS diploma or GED required
• 2+ years of prior authorization, insurance verification or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required
• Knowledge of medical terminology required
• Knowledge of payer websites, eligibility, and coordination of benefits required
• Knowledge of plan formularies and authorization requirements required
• Knowledge of pharmacy vs medical payers and authorization required
• Proficient computer skills and Microsoft Office Products required
• Computer literacy, including Windows and MS Office Suite (Outlook, Word, and Excel)
• If working at home occasionally or permanently, internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload

Benefits:

• Remote work arrangement
• Work-from-home internet service requirement with minimum speeds of 10Mbps download/5Mbps upload
• Tobacco-free policy and smoking cessation program eligibility where applicable