Prior Authorization Specialist

About the role

The Prior Authorization Specialist is responsible for obtaining prior authorizations for all prescriptions that require insurance carrier authorizations. Supervisory Responsibilities: This position has no direct supervisory responsibilities.

Essential Duties And Responsibilities

• Contact insurance carriers to verify the patient’s insurance eligibility benefits and requirements
• Request track and obtain prior authorization from insurance carriers within the time allotted
• Request follow up and secure prior authorizations ahead of prescriptions leaving the pharmacy
• Maintain a level of productivity suitable for the department
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements including proper format
• Answering questions from patients, clerical staff, and insurance companies
• Identify and resolve Prior Authorization roadblocks through various means including contacting physicians
• Participate in educational activities and attend staff meetings
• Maintain the strictest confidentiality; adhere to all HIPAA guidelines and regulations

Skills/Abilities

• Knowledge of medical billing/collection practice
• Knowledge of business office procedures
• Knowledge of basic medical coding and third-party operating procedures and practices
• Ability to operate a computer, computer software, and basic office equipment
• Ability to operate a multi-line telephone system
• Skilled in answering a telephone in a pleasant and helpful manner
• Read, understand, and follow oral and written instructions
• Establish and maintain effective working relationships with patients, employees, and the public
• Proficiency in reading, writing, and speaking English is required

Education And Experience

• Minimum 1 year of related experience required
• Pharmacy Technician Certification required (PTCB or NHA)
• Indiana and Pennsylvania State Pharmacy Technician license required, or willing to obtain before start date

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer

Compensation

The Compensation for this position is listed below. Local minimum wage laws apply. This information is posted pursuant to local requirements to provide applicants with information about what they might be eligible to receive. Individual pay decisions will depend on job-related factors such as experience, education, skill, performance, and geographic location where work will be performed. Successful candidates may be able to participate in one or more incentive compensation or short-term incentive plans, which could generate additional earnings in accordance with the terms of each plan.

Benefits

• Competitive Medical, Dental, and Vision Insurance
• HSA/FSA
• Voluntary Hospital Indemnity, Critical Illness, Accident Insurance, and Short Term Disability
• Voluntary Life Insurance for Self, Spouse and Dependent
• Company-paid Basic Life Insurance and Long Term Disability
• Retail plan and Employer match contribution with Profit Share
• Tuition Reimbursement program
• Company perks and Discount program
• Engaging Wellness and Financial Education Resources
• Employee Assistance Program
• Incentive Plans

Base Hourly Minimum

$18.00

Base Hourly Maximum

$21.00