Job Description

Job Description

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

Pharmacy Prior Authorization Specialist Primary Responsibilities:

• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Follow prior authorization work flow and policies and procedures.
• Collaborate with other departments to assist in obtaining prior authorizations.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Receive requests for prior authorizations and ensure that they are properly and closely monitored.
• Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
• Manage correspondence with insurance companies, physicians and patients as required.
• Look through denials and submit appeals if requested by physician to get them approved from insurance companies.
• Document all prior authorization information including approval dates, prior authorization number in patient profile.
• Proactively work on prior authorizations that are due to be expired.
• Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations

Pharmacy Prior Authorization Specialist Qualifications:

• Good interpersonal skills
• Excellent verbal, written and customer service skills
• Ability to work independently, meet deadlines and be flexible
• Good organizational skills and detail oriented
• Knowledge of medical terminology (including sig codes and Roman numeral), brand and generic names of medications and general pharmacy terminology is preferred
• Ability to perform tasks accurately and efficiently when inputting information
• Intermediate typing/keyboarding skills

Education/Learning Experience

• Required: High School Diploma or GED.
• Desired: Previous Experience in Pharmacy or Medical office with Prior Authorizations

Work Experience

• Desired: 1+ years pharmacy/medical office or prior authorization experience