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Prior Authorization

2 months ago

Baldwin Park, United States Polaris Pharmacy Services Full time
Job Details

Job Location
POLARIS SPECIALTY PHARMACY LLC - Baldwin Park, CA

Remote Type
Fully Remote

Position Type
Full Time

Job Category
Pharmaceutical

Description

PRIOR AUTHORIZATION SPECIALIST

OVERVIEW

The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. The Prior Authorization Specialist must be responsive and courteous when addressing our customers needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect.

RESPONSIBILITIES
  • Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers
  • Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
  • Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
  • Contact providers and/or customers as necessary to obtain additional information
  • Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes
  • Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
  • Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner
  • Review and work convert billing exception reports to ensure claims are billed to accurate financial plans
  • Complete billing transactions for non-standard order entry situations as required
  • Support training needs
  • Prepare and maintain reports and records for processing
  • Perform other tasks as assigned.
  • Follow all applicable government regulations, including HIPAA
  • Comply with departmental policies regarding safety, attendance, and dress code
  • Overtime, holidays, and weekends may be required and/or expected
  • Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
  • Other duties as assigned; Job duties may vary depending on business needs
Qualifications

QUALIFICATIONS
  • High School diploma or equivalent required
  • Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred)
  • Framework LTC & General computer knowledge & 10-key Number Entry preferred
  • Able to read, write, speak, and understand the English language
  • Able to retain a large amount of information and apply that knowledge to related situations
  • Able to work in a fast-paced environment
  • Basic computer knowledge skills required
  • Basic math and analytical skills
  • Experience with alpha-numeric data entry
  • Proficient in Microsoft Word, Excel, and Outlook required
  • Customer Service
  • Results-oriented
  • Good organization/Attention to detail
  • Reliable
  • Problem solver
  • Able to work various shifts and days
  • Adaptability to an ever-changing environment
PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
  • May sit or stand seven (7) to ten (10) hours per day
  • The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
  • May be necessary to work extended hours as needed
  • May lift and/or move up to 50 pounds
  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
HOLIDAY & PTO POLICY

We provide qualifying full-time employees with 23 PTO (Paid Time Off) days annually. PTO is used for holidays, vacation, sick leave, and personal leave.

Please note we are a long-term care pharmacy open 24-hours a day, 7 days a week. And schedules may change as determined by the needs of the business.

BENEFITS for full-time employees
  • Medical, Dental, Vision, and Health insurance
  • 401 (k) (available for Part Time & Full Time EEs)
  • Short-term and Long-term disability insurance
  • Tuition reimbursement
  • Personal Time Off (PTO)
  • Competitive pay with annual performance reviews and merit-based raises
  • Career growth potential
  • Annual on-site voluntary Flu Vaccine
  • Employee referral bonus program