Prior Authorization Specialist - Remote

POSITION SUMMARY
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Specialists are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.
REQUIRED KNOWLEDGE, SKILLS & TRAINING

• Ability to interpret medical policies.
• Ability to convert a prescription into an authorization request based on payer requirements.
• Experience with Major Medical Insurance.
• Knowledge of ICD-10 Codes (Diagnoses Codes).
• Knowledge of HCPC Codes (J-Codes).
• Knowledge of Pharmacy Benefit
• Ability to read prescriptions.
• Familiar with medical documentation such as H&P’s, Genetic testing, etc.
• Prior pharmacy experience preferred

ESSENTIAL JOB DUTIES

• Respond to urgent emails submitted by the PCC Team or Program Manager in a timely manner.
• Submit all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.
• Validate that the clinical documentation received is what is required by the plan.
• Follow up on all pending PA’s within 48 hours.
• Contact physician’s office to obtain clinical documentation that is required by the plans.
• Contact physician’s office to obtain current prescriptions.
• Initiate re-authorizations that are set to expire 30 days prior to the term date.
• Initiate prior authorizations through Cover My Meds.
• Contact plans (PBM or Major Medical) to validate request sent from BV.
• Obtain approval/ denial letters.

EMPLOYEE BENEFITS

• Delta Dental
• Life Insurance
• PTO, Holiday Pay, and Floating Holidays
• Accident & Critical Illness
• EyeMed Vision
• Tuition Reimbursement
• BCBSL Medical
• 401k