Prior Authorization Specialist

Found in: Lensa US P 2 C2 - 2 weeks ago

Pittsburgh, United States CareerBuilder Full time

Overview:
As a Prior Authorization Specialist for Specialty Medications, you will play a crucial role in facilitating the approval process for specialty medications prescribed to patients. You will be responsible for ensuring that insurance coverage requirements are met and navigating the complex landscape of prior authorization procedures. This position requires meticulous attention to detail, strong communication skills, and the ability to work collaboratively with healthcare providers, insurance companies, and patients.

Key Responsibilities:

Prior Authorization Processing:
Oversee the flow of prior authorization requests for specialty medications submitted by healthcare providers.
Ensure all necessary documentation is complete and accurate before submission to insurance providers.
Follow up on pending authorizations and provide timely updates to healthcare providers and patients.
Communicate with provider offices and insurance companies to understand their prior authorization requirements and processes. Help resolve issues holding up the approval of a prior authorization request.
Monitor vendor service levels and proactively work with vendors to resolve challenges to meet the SLAs.

Clinical Knowledge and Research:
Stay updated on the latest developments in specialty medications and insurance coverage policies.
Help maintain company payer policies and forms to ensure the most accurate information is available to prescribers.
Plan and implement coverage of new therapeutic categories.

Other
Ensure compliance with privacy regulations and maintain confidentiality of patient information.

Qualifications:
High school diploma, Bachelor's degree preferred.
Previous experience in healthcare administration, insurance coordination, or pharmacy operations, particularly in specialty medications, is required.
Strong understanding of medical terminology, pharmacy practices, and insurance billing processes.
Excellent organizational skills with the ability to prioritize tasks and manage time effectively.
Exceptional communication skills, both verbal and written, with the ability to interact professionally with healthcare providers, insurance representatives, and patients.
Proficiency in using electronic health records (EHR) systems, insurance portals, and Microsoft Office applications.
Ability to work independently with minimal supervision and collaborate effectively within a multidisciplinary team environment.

Note:

This job description is intended to outline the general nature and level of work performed by individuals assigned to this position. It is not intended to be an exhaustive list of all responsibilities, duties, and qualifications required for the role. Responsibilities and tasks may vary based on organizational needs and evolving healthcare regulations.

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