Prior Authorization Coordinator I

About the role

MedImpact Healthcare Systems, Inc. is seeking an individual to join our team as a member of the Prior Authorization Operations team. This position processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.

Responsibilities

• Processes prior authorization requests within clients' turnaround time and Performance Guarantees utilizing guidelines.
• Enters PAs into the system and prioritizes requests.
• Checks formulary alternatives, reviews tried and failed medications.
• Utilizes drug references and verifies the drug being requested is indicated and approved for the condition.
• Documents all related information regarding the PA approval or non-approval.
• Responds to requests by faxing status of the PA to the physician or pharmacy.
• Partners with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Accountable to achieve prior authorization processing productivity and accuracy standards.
• Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career path level.
• Collaborates with MCO and Self-Insured client teams to understand PBM clients' prior authorization processing requirements and expectations.
• Resolves prior authorization inquiries.
• Protects and maintains confidentiality and privacy of all prior authorization and member information.
• Collaborates with Contact Center Services in resolving prior authorization inquiries.
• Handles provider, pharmacy, and member calls to complete prior authorization and Peer to Peer requests based on client specific requirements.
• Makes outbound calls to obtain information and answer questions about prior authorization status.

Qualifications

• GED/HS Diploma and 1+ year experience or equivalent combination of education and experience.
• Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs.
• Experience with Windows based database programs.
• Must successfully complete one of the national certification exams OR obtain state licensure (in any U.S. State).
• Maintains a current Pharmacy Technician License and/or CPhT certification without restriction.

Benefits

MedImpact offers a comprehensive benefits package including medical, dental, vision, wellness programs, paid time off, company paid holidays, incentive compensation, 401K with company match, life and disability insurance, tuition reimbursement, and employee referral bonus.

Pay

$17.69 - $22.55 - $27.41 (Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.)

Schedule

This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business.

Contact Information

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers.