Prior Authorization Specialist
2 weeks ago
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.
- 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.
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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