Lead Pharmacy Prior Authorization Coordinator

Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression.

Schedule

Mon-Fri (8:30am to 5pm). This is a hybrid opportunity. Applicants must reside in, or within commutable distance to, Louisville, KY.

Benefits

• DailyPay
• Flexible schedules
• Competitive pay
• Shift differential
• Health, dental, vision, and life insurance benefits
• Company-paid short-term and long-term disability
• Tuition assistance
• Employee discount program
• 401k
• Paid-time off
• Tuition reimbursement
• Non-retail/closed-door environment

Responsibilities

• Strive to complete either approval for pharmacy claims requiring prior authorization or coordinate with prescribers and/or facility contacts to have therapy changed to a preferred alternative due to insurance not covering the treatment in question.
• Oversee new hire training completed by the Prior Authorization Coordinator II.
• Help manage staff appropriately and set clear expectations for performance.
• Work with Billing Coordinator/Supervisor/Manager in researching pharmacy accounts requiring special attention.
• Assist Billing Coordinator/Supervisor/Manager in overseeing daily prior authorization activities per policies and procedures when necessary.
• Ensure appropriate, timely, and professional communications occur with Implementation team, Account Management team, Directors of Pharmacy, and Facility staff as needed.
• Audit prior authorization functions regularly for compliance to policies, procedures, contract, and government regulations.
• Prioritize and delegate job tasks to ensure timely completion.
• Follow all applicable government regulations including HIPAA.
• Participate in projects and/or management meetings.
• Address workflow and/or business issues while keeping direct manager informed.
• Participate in various prior authorization-specific sub-groups to identify all attributes for best practice implementation and influence development of policies and procedures, as well as identify appropriate training material and educational opportunities.
• Implement proper prior authorization forms and forward them to physicians to obtain approval.
• Complete change of therapy forms to facility contacts and physicians.
• Adjudicate claims, research formularies for numerous insurance plans, contact physician’s office, update spreadsheets on a daily basis, follow up, and obtain approval or denial of prior authorizations.
• Communicate timely and courteously to the physician/clinical staff regarding authorization status or delays.
• Oversee and approve updates made to the Prior Authorization Training Manuals by the Pharmacy Prior Authorization Coordinator II.

Requirements

• High School Diploma/GED required.
• Pharmacy Tech License preferred.
• Excellent customer service and communication skills, both written and verbal.
• Ability to prioritize and meet pre-determined deadlines.
• Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills.
• Experience in healthcare billing environment (pharmacy preferred).
• Familiarization with online claims processing and Medicaid and Medicare billing practices.
• Proficient with Microsoft Word & Excel required.
• If a current PAL employee, you must:
  • Have 6+ months of prior authorization experience as PAL Core Prior Authorization Coordinator.
  • Adhere to Pharmacy Alternatives, LLC attendance policy.
  • Excel and adhere to core Pharmacy Alternative Prior Authorization responsibilities.
  • Not be on any form of Performance Improvement/Corrective Action Plan.

About Our Line of Business

PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success.