Prior Authorization Specialist

2 weeks ago


Livingston, California, United States Asembia Full time
Job Title: Prior Authorization Specialist

As a Prior Authorization Specialist at Asembia, you will play a critical role in ensuring seamless patient care and outcomes in the specialty pharmacy industry.

Key Responsibilities:
  • Assist with prior authorizations, appeals, and denials to ensure timely and accurate processing.
  • Update and verify patient insurance information to ensure accurate billing and reimbursement.
  • Sort and prioritize daily work queues to identify and process authorizations and claims efficiently.
  • Maintain knowledge of insurance benefit terms and processes to ensure compliance and accuracy.
  • Effectively communicate with the care team, including physicians, practice staff, and payers, to resolve issues and ensure patient care.
  • Request and prepare supporting documentation, such as medical records and prescriptions, to support prior authorization requests.
  • Investigate authorization denials and appeals to resolve issues and ensure patient care.
  • Obtain and review clinical notes from physicians to assist in filling out prior authorization forms.
  • Submit completed prior authorization requests via ePA or other methods as necessary.
  • Initiate and obtain appeal required documentation from physicians.
  • Follow up with physicians and insurance companies on the status of prior authorizations, appeals, and denials.
Requirements:
  • Minimum of 2 years of pharmacy experience, preferably in a prior authorization role.
  • General knowledge of pharmacy laws, practices, and procedures.
  • Knowledge of common medical terms and abbreviations, as well as pharmacy calculations.
  • Understanding of insurance and third-party billing systems.
  • Excellent communication, organization, and time management skills.
  • Ability to work independently and as part of a team.
  • Proficient in MS Word, Excel, and Outlook.
About Asembia:

Asembia is a leading industry voice and advocate, committed to bringing strategic channel management solutions, leading-edge products, and high-touch services to the specialty pharmacy industry. We are dedicated to optimizing patient care and outcomes, and we are seeking a skilled Prior Authorization Specialist to join our team.



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