Prior Authorization Specialist

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

Lansing, United States Tekwissen Full time
Overview:

Tek Wissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Prior Authorization Specialist

Work Location: Lansing, MI 48901

Duration: 2 Months

Job Type: Contract

Work Type: Remote

Job Description

Department: Pharmacy Technician

Engagement Description:

RESPONSIBILITIES/TASKS:

  • Answer telephones in an efficient and timely manner to lend appropriate assistance to providers Process prior authorization requests under the supervision of a Clinical Pharmacist.
  • Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests.
  • Analyzing written, faxed, and verbal inquiries which leads to entry of pharmacy authorizations into the system.
  • Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool.
  • Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.
  • Perform other related duties as assigned.
  • This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:
  • High School Graduate of GED equivalent required. Two (2) years of college preferred.

EXPERIENCE:
  • Two (2) years' experience in retail or hospital Pharmacy required.
  • Pharmacy Technician Certification (PTCB) preferred Knowledge of prescription drug names, therapeutic classes and claims processing Experience with Medicare Part D prescription benefits may be preferred for some positions

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Knowledge of pharmacy claims processingUnderstanding of formularies and utilization management editsFamiliarity with Medicare Guidelines and Timeframes Computer Literate (Microsoft Office Products).
  • Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence.
  • Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.


TekWissen Group is an equal opportunity employer supporting workforce diversity.

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