Authorization Specialist II

Essential Duties & Responsibilities

• Initiates prior medical/pharmacy authorization requests for referrals.
• Follows Prior Authorization Criteria for medications and submits requests.
• Communicates with insurance companies to pre-certify/authorize medications.
• Obtains clinical information (medical history, diagnosis, relevant lab reports) necessary to complete the Prior Authorization.
• Reviews clinical information for completeness and follows up with any questions.
• Handles complex authorization requests and issues as needed.

Requirements

• Education: High school diploma or GED required.
• Experience: One-year related experience and/or training with a healthcare organization, retail, or mail order pharmacy, or PBM.
• Experience with completing referrals and navigating insurance portals and orders.
• Experience working in a highly productive department with strong metrics accountability/ownership.
• Functional Competencies: Attention to detail, critical thinking, problem solving, approachable, phone etiquette, dependable, verbal and written communication, teamwork, cooperation, collaboration, judgment, initiative, follow-through, Ability to prioritize and multi-task when presented with multiple duties, Self-starter with the ability to work independently and as part of a team.