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

• Monday–Friday, 8:30 AM to 5:00 PM
• Hybrid opportunity; applicants must reside in or be commutable to Louisville, KY

Benefits

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

Responsibilities

• Complete approval for pharmacy claims requiring prior authorization or coordinate with prescribers and/or facility contacts to change therapy to a preferred alternative when insurance does not cover the treatment
• Oversee new-hire training completed by the Prior Authorization Coordinator II
• Manage staff appropriately and set clear performance expectations
• Work with Billing Coordinator/Supervisor/Manager to research pharmacy accounts requiring special attention
• Assist Billing Coordinator/Supervisor/Manager in overseeing daily prior authorization activities per policies and procedures
• Ensure appropriate, timely, and professional communications with Implementation team, Account Management team, Directors of Pharmacy, and Facility staff
• Audit prior authorization functions regularly for compliance with policies, procedures, contracts, 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 prior authorization sub-groups to identify best practices, influence policy development, and identify training opportunities
• Implement proper prior authorization forms and forward them to physicians for approval
• Complete change-of-therapy forms for facility contacts and physicians
• Adjudicate claims, research formularies, contact physician offices, update spreadsheets daily, and follow up to obtain approval or denial of prior authorizations
• Communicate authorization status or delays to physician/clinical staff in a timely and courteous manner
• Oversee and approve updates to the Prior Authorization Training Manuals by the Pharmacy Prior Authorization Coordinator II

Qualifications

• 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
• Proficiency in multi-tasking, typing, and advanced technical skills
• Experience in healthcare billing environment (pharmacy preferred)
• Familiarization with online claims processing and Medicaid/Medicare billing practices
• Proficient with Microsoft Word & Excel
• If a current PAL employee: 6+ months of prior authorization experience as PAL Core Prior Authorization Coordinator, adherence to attendance policy, and no active Performance Improvement/Corrective Action Plan

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 nationwide, we combine the personal touch of a neighborhood pharmacy with the resources of a national network.