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Pharmacy Authorization Specialist

2 months ago

Lakeland, Florida, United States WELLDYNE Full time
Job Description

**Job Summary**

WellDyne is seeking a highly organized and detail-oriented Pharmacy Prior Authorization Coordinator to join our team. As a Pharmacy Prior Authorization Coordinator, you will be responsible for obtaining and renewing authorizations for medical and/or pharmacy payors. This role requires strong communication and problem-solving skills, as well as the ability to work effectively in a fast-paced environment.

**Key Responsibilities**

  • Initiates Prior Authorizations, Pre-Certifications, Pre-Determinations, and Advanced Benefit Determination requests for new and existing patients.
  • Performs pharmacy test claims and follows up regarding results.
  • Works with patients to identify and assess reimbursement coverage options for those with insurance and coordinates and/or investigates financial options for those without insurance.
  • Collaborates with physician offices to facilitate the process of obtaining prior authorization from third-party payers to maximize patients' access to treatment.
  • Supports the appeal process to overturn insurance denials and/or benefit exclusions when needed.
  • Works with Intake, Billing, and Collection teams to resolve claims issues.
  • Maintains confidentiality of all Protected Health Information (PHI) in compliance with state and federal law.

**Requirements**

  • High School Diploma or equivalent required.
  • Florida Pharmacy Technician License preferred.
  • Previous Prior Authorization and Claims experience is preferred.

**What We Offer**

  • Medical, Dental, and Vision Benefits.
  • Medical Savings Account Options with Company match.
  • 401K after 90 days of employment.
  • Employee Assistance Program.
  • Life and Supplemental insurance.
  • Educational Reimbursement.
  • Paid Time Off.

**Work Environment**

This position is in a typical office environment, requiring prolonged sitting and standing in front of a computer. Additionally, this position requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment.