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The Authorization Processing Specialist is a vital member of the Prior Authorization Operations team, responsible for managing and processing prior authorization requests in alignment with established standards for accuracy, efficiency, and client performance commitments.
Key Responsibilities:- Process and finalize prior authorization requests within designated turnaround times and performance guarantees.
- Utilize various business applications to conduct analyses, gather information, and input prior authorization data essential for claims adjudication.
- Employ critical thinking skills to identify missing information and make informed processing decisions based on clinical protocols and client guidelines.
- Engage with internal and external stakeholders to provide and gather information, ensuring exceptional service delivery.
- Work under general supervision, following established guidelines, policies, and procedures to fulfill job functions.
- Collaborate with clinical pharmacists to ensure compliance with administrative processing boundaries and timelines.
- Maintain confidentiality and privacy of all prior authorization and member information, adhering to strict protocols for data management.
The ideal candidate will possess an Associate degree or equivalent experience, with a preference for individuals with a background in healthcare organizations, retail, or pharmacy benefit management. Proficiency in MS Office applications and familiarity with pharmacy software is essential.
Skills and Abilities:- Strong attention to detail and accuracy in processing requests.
- Ability to prioritize tasks effectively in a fast-paced environment.
- Excellent communication skills, both written and verbal.
- Demonstrated problem-solving abilities and a proactive approach to challenges.
This role is primarily office-based, requiring the ability to work effectively in a team-oriented environment while also being self-motivated.
Benefits:MedImpact offers a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, and a 401K plan with company matching.
