Pharmacy Prior Authorization Specialist
2 weeks ago
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.
- 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.
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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