Prior Authorization Specialist - Remote

Description

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

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

ESSENTIAL JOB DUTIES

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

EMPLOYEE BENEFITS

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