Prior Authorization Specialist

Prior Authorization Specialist

PHIL is looking for a full-time Prior Authorization Specialist - with a focus on pharmacy support for Monday through Friday shifts.

Founded in 2015, PHIL is a San Francisco-based Series D health-tech startup, pioneering the first Software Therapy Deployment Platform for Specialty Pharmaceuticals that treat complex health conditions. Our mission is to ensure consistent, reliable and affordable access to complex therapeutics for our patient community. Partnering with pharmaceutical manufacturers, PHIL offers digital patient access services to improve health outcomes for patients by delivering affordable and timely access to high-cost Specialty therapeutics. Headquartered in Scottsdale with operational hubs in Scottsdale AZ and Columbus, OH, the company currently employs over 120 individuals and expects to double its employee base in the coming year.

The most important goal here at PHIL is to improve patients' medication adherence by offering a quick and effortless way for patients to get their medications on time. Prior Authorization Specialists ensure that prescribing offices have all of the information that they need in order to efficiently complete electronic coverage requests in addition to providing phone and email support.

Job Duties:

• Verifies patient insurance coverage utilizing phone or online resources
• Submit prior authorizations to insurance plans in a timely manner via electronic portal
• Troubleshoots prior authorization submissions and prescription processing with health care providers utilizing phone or online resources
• Verbally assist providers in navigating appeals processing
• Ensures all pertinent medical documentation is accurate and present prior to authorization submission
• Compiles trends in authorization determinations for client and prescriber education
• Document activities appropriately in process notes using our operating system
• Work closely with our Customer Support team to ensure the success of patients that are recommended to us by their physician's office

Requirements:

• Proven team player, but can solve problems independently as well
• Exceptional written and verbal communication skills
• Easily adapt to new system and workflow changes
• Demonstrate experience working in prior authorizations, medical insurance billing, and/or health insurance (required)
• Working knowledge of ICD-10 codes and prescription drug names (preferred, but not required)
• Ability to successfully navigate between multiple systems throughout the course of the workday, this includes but is not limited to operational software and vendor portals
• Demonstrate flexibility to perform duties wherever volume deems it necessary
• Customer service experience (preferred)
• Access to reliable, high-speed internet to meet the needs of remote processing (required)
• Reliable transportation and ability to work in office as required

Benefits:

• Ground floor opportunity with one of the fastest-growing startups in health-tech
• Fully remote working environment available in the following states: AZ, CA, CO, FL, GA, IA, ID, IL, IN, MA, MI, MO, NC, NH, NJ, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV
• Solve a problem that matters: be part of a company that uniquely leverages technology to bring wellness to all of its stakeholders