Prior Authorization Specialist Jobs

In this role, you will be responsible for:

∙ Utilizing multiple software systems to complete Medicare Prior Authorization case reviews.

∙ Meeting or exceeding government mandated timelines

∙ Complying with turnaround time, productivity and quality standards.

∙ Conveying resolution to beneficiary or provider via direct communication and professional correspondence

∙ Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.

Required Qualifications:

∙ Accountable and results driven.

∙ Critical thinker/problem solver

∙ Receptive to constructive feedback and flexible in adapting to change.

∙ Ability to effectively plan, prioritize, and organize time and workload.

∙ Ability to execute successfully in a deadline-oriented, fast-paced, highly regulated environment.

∙ Proficient in navigation of multiple computer applications

∙ Proficient use of keyboard, mouse, and ability to navigate 2 workstation monitors.

∙ Ability to type more than 30 WPM.

Preferred Qualifications:

∙ Six months of PBM/pharmaceutical related work strongly desired.

∙ At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service.

Education:

∙ High School Diploma or GED required.

∙ Bachelor’s degree in related field or equivalent work experience preferred.

Opportunity for full-time employment contingent on performance.

Virtual interviews with supervisors via WebEx or phone.

Hours of operation 8-8 EST M-F with rotating weekend schedules.

Please fil the answers of these Questionnaire:

In this role, contracted Prior Authorization Rep II's will perform setup and initial review of prior authorization requests. He/she will utilize tools to apply the appropriate clinical criteria or guidelines, policy, and procedure to process the case according to our work instructions.

1. Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned). All time off needed should be discussed and disclosed during this initial review.
2. After training, our hours of operation are 7-8 EST M-F with rotating weekend schedules 7am-3:30pm local time (EST/CST - usually every 4^th weekend) – they must be available for the rotating weekend.
3. This is a work from home (WFH) position so must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.
4. Must be able to sit and focus on work for the duration of shift.
5. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
6. Pharmacy or medical background is preferred.
7. Successfully worked independently in a data entry, productivity driven role is preferred.
8. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal