Pharmacy Authorization Specialist
2 weeks ago
PHARMACY AUTHORIZATION SPECIALIST
Company Overview
BrightSpring Health Services is dedicated to providing exceptional healthcare solutions tailored to the needs of our clients. We operate in a non-retail pharmacy environment, focusing on the pharmaceutical requirements of long-term care and senior living facilities. Our organization is experiencing significant growth, offering numerous career advancement opportunities for motivated individuals.
Position Overview
The Pharmacy Authorization Specialist plays a crucial role in managing pharmacy claims that require prior authorization. This position involves collaborating with healthcare providers and facility representatives to ensure that clients receive the necessary medications, even when insurance coverage is limited.
Work Schedule
This position typically follows a Monday to Friday schedule from 8 AM to 5 PM Central Time. After an initial training period, employees will have the flexibility to work in a hybrid model, balancing time between the office and their home workspace.
Key Responsibilities
- Facilitate the timely and accurate completion of prior authorization requests and therapy modifications by liaising with prescribers and facility contacts.
- Conduct follow-ups on all claims requiring prior authorization within a four to five business day timeframe.
- Maintain tracking of all claims in the designated system and provide weekly updates to the Pharmacy Director.
- Review unbilled claims to ensure all necessary prior authorizations are addressed promptly.
- Assist the Billing Department in resolving any unbilled claims during the month-end close process.
- Advocate for clients when necessary to ensure their pharmaceutical needs are met.
- Support pharmacy operations and assist in resolving claim rejections as required.
- Utilize various software systems to manage daily workflows effectively.
- Perform additional duties as assigned.
Qualifications
- High School Diploma or General Education Diploma is required.
- A Pharmacy Technician License in Kentucky is preferred.
- Strong customer service and communication skills, both written and verbal.
- Ability to prioritize tasks and meet established deadlines.
- Proficient in multitasking, typing, and possessing advanced technical skills.
- Experience in a healthcare billing environment, preferably in pharmacy.
- Familiarity with online claims processing and billing practices for Medicaid and Medicare.
- Proficient in Microsoft Word and Excel.
About Us
BrightSpring Health Services is committed to delivering high-quality pharmacy solutions for individuals with diverse healthcare needs. Our focus on service excellence and quality care positions us as a leader in the industry. We offer a supportive work environment that fosters professional growth and development.
Compensation
The hourly wage for this position is competitive, reflecting the skills and experience of the candidate.
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