Prior Authorization Specialist
Our Company
Pharmacy Alternatives
Overview
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!
The ideal candidate has experience in healthcare billing environment (pharmacy preferred) and is familiar with on-line claims processing and Medicaid and Medicare billing practices
Schedule: Mon-Fri(8:30am to 5pm)
This is not a remote opportunity. Applicants must reside in, or commutable distance, to Louisville, KY. A Hybrid schedule will be available after training: office on Wednesdays and home off on other days
We offer:
DailyPay
Flexible schedules
Competitive pay
Shift differential
Health, dental, vision and life insurance benefits
Company paid STD and LTD
Tuition Assistance
Employee Discount Program
401k
Paid-time off
Tuition reimbursement
Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!
*Position will be posted for a minimum of 7 business days
Responsibilities
- 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
Essential Job Responsibilities:
- Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts
- Follows up on all claims requiring prior authorization within four to five business days
- Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis
- Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on
- Assists Billing Department with resolving unbilled claims at each month end close
- Advocates for clients as needed
- Support for Pharmacy Operations
- Adjudicates and resolution of claim rejections as needed
- Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis
- Other responsibilities as assigned
Qualifications
- 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 on-line claims processing and Medicaid and Medicare billing practices
- Proficient with Microsoft Word & Excel required