Pharmacy Prior Authorization Specialist

1 day ago


Lafayette, Louisiana, United States Professional Arts Specialty Pharmacy Full time
Job Title: Pharmacy Prior Authorization Specialist

At Professional Arts Specialty Pharmacy, we are seeking a highly skilled Pharmacy Prior Authorization Specialist to join our team. As a Pharmacy Prior Authorization Specialist, you will play a critical role in ensuring that patients receive the medication they need by navigating the prior authorization process.

Key Responsibilities:

  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Follow prior authorization workflow and policies and procedures.
  • Collaborate with other departments to assist in obtaining prior authorizations.
  • Review accuracy and completeness of information requested and ensure that all supporting documents are present.
  • Receive requests for prior authorizations and ensure that they are properly and closely monitored.
  • Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
  • Manage correspondence with insurance companies, physicians, and patients as required.
  • Look through denials and submit appeals if requested by physicians to get them approved from insurance companies.
  • Document all prior authorization information, including approval dates and prior authorization numbers, in patient profiles.
  • Proactively work on prior authorizations that are due to be expired.
  • Ensure patients' demographics and medical information are secure by using great discretion and adhering to HIPAA compliance and regulations.

Requirements:

  • Good interpersonal skills
  • Excellent verbal, written, and customer service skills
  • Ability to work independently, meet deadlines, and be flexible
  • Good organizational skills and attention to detail
  • Knowledge of medical terminology, including sig codes and Roman numerals, brand and generic names of medications, and general pharmacy terminology
  • Ability to perform tasks accurately and efficiently when inputting information
  • Intermediate typing/keyboarding skills

Education/Learning Experience:

  • Required: High School Diploma or GED
  • Desired: Previous experience in pharmacy or medical office with prior authorizations

Work Experience:

  • Desired: 1+ years of pharmacy/medical office or prior authorization experience


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