Lead Pharmacy Prior Authorization Coordinator

Job Description

Job Description

Overview

Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode , which means advancement opportunities for individuals who are looking for career progression!

Schedule : Mon-Fri(8:30am to 5pm)

This is a hybrid opportunity . Applicants must reside in, or commutable distance, to Louisville, KY

We offer:

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health, dental, vision and life insurance benefits

Company paid STD and LTD

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Non-retail/Closed-door environment

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

*Position will be posted for a minimum of 7 business days

Responsibilities

The Pharmacy Lead Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or coordinating with prescribers and/or facility contacts to have therapy changed to a preferred alternative due to insurance not covering the treatment in question. The Pharmacy Lead PA Coordinator also oversees new hire training completed by the Prior Authorization Coordinator II.

• Helps manage staff appropriately and sets clear expectations for performance
• Works with Billing Coordinator/Supervisor/Manager in researching pharmacy accounts requiring special attention
• Assists Billing Coordinator/Supervisor/Manager in overseeing daily prior authorization activities per policies and procedures when necessary
• Ensures appropriate, timely and professional communications occurs with Implementation team, Account Management team, Directors of Pharmacy, and Facility staff as needed
• Audits prior authorization functions regularly for compliance to policies, procedures, contract and government regulations
• Prioritizes and delegates job tasks to ensure timely completion
• Follows all applicable government regulations including HIPAA
• Participates in projects and/or management meetings
• Addresses workflow and/or business issues while keeping direct manager informed
• Participates on various prior authorization specific sub-groups to identify all attributes for best practice implementation and influences development of policies and procedures as well as identifies appropriate training material and educational opportunities
• Implements proper prior authorization forms and forwards them to physicians to obtain approval
• Completes change of therapy forms to facility contacts and physicians
• Adjudicates claims, researching formularies for numerous insurance plans, contacting physician’s office, updating spreadsheets on a daily basis, follow-up and obtain approval or denial of prior authorizations
• Communicates timely and in a courteous manner to the physician/clinical staff regarding authorization status or delays
• Oversees and approves updates made to the Prior Authorization Training Manuals by the Pharmacy Prior Authorization Coordinator II

Qualifications

• High School Diploma/GED required
• Pharmacy Tech License preferred
• Excellent customer service and communication skills, both written and verbal
• Ability to prioritize and meet pre-determined deadlines
• Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
• Experience in healthcare billing environment (pharmacy preferred)
• Familiarization with online claims processing and Medicaid and Medicare billing practices
• Proficient with Microsoft Word & Excel required
• If a current PAL employee, you must:
  • Have 6+ months of prior authorization experience as PAL Core Prior Authorization Coordinator
  • Adhere to Pharmacy Alternatives, LLC attendance policy
  • Excel and adhere to core Pharmacy Alternative Prior Authorization responsibilities
  • Not be on any form of Performance Improvement/Corrective Action Plan