Pharmacy Prior Authorization Specialist
1 day ago
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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