Prior Authorization Coordinator

About the role

VerusRx is a small, but rapidly growing Pharmacy Benefit Manager (PBM) with a strong emphasis on teamwork, open communication, and maintaining a healthy work-life balance. We value diversity and promote equality, inclusion, and a modern, progressive approach. As a "Great Place to Work," our mission is to support members throughout their healthcare journey.

Responsibilities

• Assist with calls transferred from Member Service Representatives (MSRs) for prior authorization-related issues
• Research and resolve questions from members, providers, pharmacies, and other callers, including explaining PA denials
• Document callers’ questions, issues, and resolution in the CRM (Dynamics)
• Send outbound PA request forms via fax to provider offices to initiate prior authorizations and follow up by phone as needed to obtain required clinical documentation
• Respond to emails to initiate prior authorizations and address PA status inquiries from internal and external stakeholders (e.g., providers, members, internal teams)
• Finalize PA orders following clinical review by a Pharmacist or PA Technician, documenting the decision in the CRM (Dynamics) and entering overrides upon approval
• Monitor assigned queue(s) and case volume to help meet turnaround time (TAT) targets
• Perform other duties as assigned

Qualifications

• Minimum of 2 years’ experience in PBM or related (retail or hospital pharmacy)
• C.Ph.T license desired
• Ability to work cooperatively
• Ability to master computer/software applications necessary for completing job tasks as required
• Ability to understand functionality of applications for processing PA reviews (data entry)

Other Details

• Supervisory Responsibilities: None
• Work Environment: Noise level is usually low to moderate. Physical demands include regular talking or hearing, frequent use of hands and fingers, occasional lifting up to 25 pounds, and reaching with hands and arms.
• Physical Demands: Reasonable accommodation may be made to enable individuals with disabilities to perform the functions. Specific vision abilities required include close vision, distance vision, and the ability to adjust focus.
• Travel Requirements: None