Senior Prior Authorization Representative

Careers with real impact.Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.ABOUT ORSINIProviding compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™OUR MISSIONOrsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™. CORE VALUESAt the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.COMPENSATION & LOCATIONThe salary range for this role is $25.00This position is based out of Elk Grove Village, IL. POSITION SUMMARYThe Sr. Prior Authorization Representative will work closely within the Admissions department processing patient drug referral prior authorization (PA) requests, performing status checks, validating payor requirements for assigned drugs, contacting provider offices, and other related functions. In addition, the Senior Prior Authorization role will be responsible for training new Prior Authorization employees on department processes, procedures and company software systems. This role will be a key resource for on-going training and development needs for the Prior Authorization team and has expert knowledge with pharmacy and medical prior authorization submissions, benefit verification process, excel spreadsheets and medical policies.ESSENTIAL DUTIESContact plans (PBM or Major Medical) to validate request sent from BV Team.Contact physician’s office to obtain current prescriptions.Contact physician’s office to obtain clinical documentation that is required by the plans.Validate that the clinical documentation received is what is required by the plan.Initiate prior authorization request to the major medical plans via fax or plan portals.Initiate prior authorizations request through Cover My Meds for pharmacy benefit request.Follow up on all pending PA’s within 48 hours.Respond to urgent emails submitted by the PCC Team or Program Manager in a timely manner.Obtain approval/ denial letters.Submit all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.Initiate re-authorizations that are set to expire 30 days prior to the term date.Train new hires on our prior authorization process through the major medical and pharmacy benefit.Submit New Start spreadsheet to the prior authorization team in a timely manner.Ensure that all New Start updates has been received and merge updates in a timely manner.Maintain the New Start spreadsheet.Ability to create an accurate profit and loss for medical and pharmacy benefits.Other duties and responsibilities as required. Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description. KNOWLEDGE, SKILLS, AND TRAININGExperience with Major Medical Insurances.Experience with Pharmacy Benefits.Knowledge of HCPC Codes (J-Codes).Knowledge of ICD-10 Codes (Diagnoses Codes).Familiar with medical documentation such as H&P’s, Genetic testing, Labs etc.Ability to read prescriptions.Ability to convert a prescription into an authorization request based on payer requirements.Ability to interpret medical policies.Ability to assist and train new staff.EMPLOYEE BENEFITSWe offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:Medical Coverage, Dental, and Vision Coverage401(k) with employer matchAccident and Critical Illness coverageCompany-paid life insurance optionsGenerous PTO, paid holidays, and floating holidaysTuition reimbursement program.SummaryLocation: Elk Grove Village, IL, United StatesType: Full TimeExperience: Mid LevelDepartment: Admissions