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Pharmacy Prior Authorization Specialist
2 months ago
We are seeking a highly skilled Prior Authorization Coordinator to join our team at Pharmacy Alternatives, a specialized pharmacy provider focused on serving individuals with cognitive, intellectual, and developmental disabilities (I/DD). As a Prior Authorization Coordinator, you will play a critical role in ensuring that our clients receive the necessary pharmacy services to live their best lives.
Job Summary:The Prior Authorization Coordinator is responsible for coordinating with prescribers and facility contacts to obtain prior authorization for pharmacy claims. This role requires excellent communication and organizational skills, as well as the ability to work in a fast-paced environment.
Key Responsibilities:- Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork
- Follow up on all claims requiring prior authorization within four to five business days
- Track and review all claims in QuickBase and send an Excel tracking spreadsheet to the Director of Pharmacy on a weekly basis
- Compare system reports of unbilled claims requiring prior approval to QuickBase tracking systems to ensure any claim requiring prior authorization is being followed up on
- Assist the Billing Department with resolving unbilled claims at each month-end close
- Advocate for clients as needed
- Support Pharmacy Operations
- Adjudicate and resolve claim rejections as needed
- High School Diploma/General Education Diploma required
- Kentucky Pharmacy Technician License preferred
- Excellent customer service and communication skills, both written and verbal
- Ability to prioritize and meet pre-determined deadlines
- Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
- Experience in healthcare billing environment (pharmacy preferred)
- Familiarization with online claims processing and Medicaid and Medicare billing practices
- Proficient with Microsoft Word & Excel required
Pharmacy Alternatives, a PharMerica company, is a specialized pharmacy provider focused on serving individuals with cognitive, intellectual, and developmental disabilities (I/DD). We are committed to providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide.
We offer a non-retail pharmacy environment, flexible schedules, competitive pay, shift differential, health, dental, vision, and life insurance benefits, company-paid STD and LTD, tuition assistance, employee discount program, 401(k), paid-time off, tuition reimbursement, and a non-retail/closed-door environment.
