Pharmacy Prior Authorization Specialist
- Louisville, KY
- Permanent
- Full-time
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits - life; and short and long-term disability
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Follow prior authorization work flow and policies and procedures.
- Collaborate with other departments to assist in obtaining prior authorizations.
- Review accuracy and completeness of information requested and ensure that all supporting documents are present.
- Receive requests for prior authorizations and ensure that they are properly and closely monitored.
- Consult with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate.
- Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
- Manage correspondence with insurance companies, physicians and patients as required.
- Look through denials and submit appeals if requested by physician to get them approved from insurance companies.
- Document all prior authorization information including approval dates, prior authorization number in patient profile.
- Proactively work on prior authorizations that are due to be expired.
- Secure patients' demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation
- Good interpersonal skills
- Excellent verbal, written and customer service skills
- Ability to work independently, meet deadlines and be flexible
- Good organizational skills and detail oriented
- Knowledge of medical terminology (including sig codes and Roman numeral), brand and generic names of medications and general pharmacy terminology
- Ability to perform tasks accurately and efficiently when inputting information
- Licensed/registered pharmacy technician or as required by state law
- Basic math and analytical skills
- Intermediate typing/keyboarding skills
- Required: High School Diploma or GED. Previous Experience in Pharmacy and Prior Authorizations
- Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
- Required: 1+ years pharmacy or prior authorization experience
- Desired: 3+ years pharmacy or prior authorization experience
- Required: Prior authorization process, CoverMyMeds experience, knowledge/understanding of pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
- Desired: Specialty pharmacy experience
- Required: Registration with Board of Pharmacy as required by state law
- Desired: Certified Pharmacy Technician (PTCB)
- Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills