Prior Authorization Specialist

Job Description

Job Description

JOB DESCRIPTION

A closed door pharmacy is looking to hire a Prior Authorization Specialist. This role will include assisting in the initiation of new prior auth requests, identifying correct forms required for patients insurance, coordinating information for forms, and following up with medical offices. These individuals must have experience working in a previous pharmacy setting and must have a strong ability to multitask.

Responsibilities:
• Process pharmacy claims accurately and timely to meet client expectations
• Triage rejected pharmacy insurance claims to ascertain patient pharmacy benefits coverage
• Maintain compliance with patient assistance program guidelines
• Document all information and data discovery according to operating procedures
• Research required information using available resources
• Maintain confidentiality of patient and proprietary information
• Perform all tasks in a safe and compliant manner that is consistent with corporate policies as well as State and Federal laws
• Work collaboratively and cross-functionally between management, the Missouri-based pharmacy, compliance and engineering

REQUIRED SKILLS AND EXPERIENCE

• 1+ year(s) working with prior authorizations or insurance verification in a pharmacy
• High school diploma or GED required, Bachelor’s degree strongly preferred
• Customer service or inbound call center experience required
• Sound technical skills, analytical ability, attention to detail, good judgment, and strong operational focus
• Must be flexible to work shifts ranging from 8am - 8pm.

NICE TO HAVE SKILLS AND EXPERIENCE

• 1+ year(s) working with prior authorizations or insurance verification in a pharmacy
• Knowledge of pharmacy benefits and pharmacy claims