Pharmacy Prior Authorization Specialist

2 weeks ago


Louisville, Kentucky, United States BrightSpring Health Services Full time
About the Role

We are seeking a skilled Pharmacy Prior Authorization Coordinator to join our team at BrightSpring Health Services. As a Pharmacy Prior Authorization Coordinator, you will play a critical role in ensuring the timely and accurate completion of prior authorization and change of therapy paperwork for our clients.

Key Responsibilities
  • Collaborate with prescribers and facility contacts to 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 a weekly tracking spreadsheet to the Director of Pharmacy.
  • 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 by adjudicating and resolving claim rejections as needed.
  • Utilize Frameworks, QuickBase, Docutrack, and CoverMyMeds to complete workflow on a daily basis.
Requirements
  • 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 a healthcare billing environment (pharmacy preferred).
  • Familiarization with online claims processing and Medicaid and Medicare billing practices.
  • Proficient with Microsoft Word & Excel required.
About Our Company

BrightSpring Health Services is a specialized pharmacy provider focused on serving individuals with cognitive, intellectual, and developmental disabilities (I/DD). We offer a non-retail pharmacy environment and a hybrid schedule with time spent in the office as well as your home office. We provide competitive pay, daily pay, flexible schedules, and a range of benefits including health, dental, vision, and life insurance, as well as tuition assistance and an employee discount program.



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