Job description

• 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
• Understanding of insurance companies, billing practices, eligibility checks, secondary pay sources, Medicare (A vs. B vs. D vs. Advantages plans), prior authorizations.

Pharmacy Prior Authorization Specialist Qualifications:

• 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
• Willingness to obtain or maintain a Pharmacy Technician License
• Basic math and analytical skills
• Intermediate typing/keyboarding skills

Job Type: Full-time

Pay: Up to $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• Weekend availability

Ability to commute/relocate:

• Arkadelphia, AR 71923: Reliably commute or planning to relocate before starting work (Required)

License/Certification:

• Pharmacy Technician License (Preferred)

Willingness to travel:

• 25% (Required)

Work Location: One location

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