Prior Authorization Specialist
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!
About the role
The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and/or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question.
Responsibilities
- Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts
- Follow up on all claims requiring prior authorization within four to five business days
- Track and review all claims in QuickBase and send Excel tracking spreadsheet to Director of Pharmacy on weekly basis
- Compare system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on
- Assist Billing Department with resolving unbilled claims at each month-end close
- Advocate for clients as needed
- Support for Pharmacy Operations
- Adjudicate and resolve claim rejections as needed
- Utilize Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on a daily basis
- Other responsibilities as assigned
Requirements
- High School Diploma/General Education Diploma required
- Kentucky Pharmacy Technician 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
Schedule
- Monday–Friday, 8:30 AM to 5:00 PM
- This is not a remote opportunity; applicants must reside in or be within commutable distance to Louisville, KY
- Hybrid schedule available after training: office on Wednesdays, remote on other days
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
About Our Line of Business
Pharmacy Alternatives®, an affiliate of PharMerica, is a specialized pharmacy provider focused on serving individuals with cognitive or intellectual and developmental disabilities (I/DD). Pharmacy Alternatives offers long-term pharmacy solutions specializing in serving special-needs populations who live in intermediate care facilities, waiver homes, group homes, assisted living, supported-living, or foster care. Our state-of-the-art approach includes packaging technology specially designed for the population we serve and electronic medication management that helps people live their best lives.