Authorization Specialist II

CarepathRx

79d

About The Position

This position is responsible to oversee the requesting and obtaining authorizations for specialty and infusion pharmacy. Manage the review of initial prior authorization requests and renewal authorizations. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations. Additional responsibilities include orientation and mentoring new staff and daily oversight of team members. Also, monitoring the performance of the authorization team and create and update policies and procedures.

Requirements

• HS diploma or GED required
• 2+ years of pharmacy claims, pharmacy tech, and/or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting, preferred
• Knowledge of medical terminology, coordination of benefits
• Knowledge of payer websites preferred
• Knowledge of medical terminology preferred
• Knowledge of pharmacy payers and authorization requirements preferred
• Proficient computer skills and Microsoft Office Products, preferred
• Excellent customer service skills
• Self-starter with the ability to work with minimum supervision

Responsibilities

• Oversees and maintains expertise in assigned areas of specific responsibility such as formulary exceptions, prior authorization requirements and time frames according to line of business and payer.
• Ensures initial and renewal authorizations are followed up on appropriately.
• Directs the daily operations/workflow of the authorization specialist in accordance with patient care needs, department strategic plan, and appropriate accreditation standards.
• Create work schedules, implement guidelines, conduct staff meetings and update personnel on company updates i.e., internal processes and contracts.
• Manage recruitment, hiring, training, evaluation, and competency of personnel; maintains a quality workforce.
• Monitors performance and compliance of reporting personnel and provides feedback via performance evaluations and disciplinary action when necessary.
• Initiates disciplinary action and makes recommendations for corrective action and improvement of performance.
• Ensure achievement of productivity standards and adherence to regulations and standards of performance and accreditation.
• Collaborate with the team to identify efficiencies.
• Acts as a resource to all personnel to resolve problems and answer questions regarding intake operations.
• Takes the initiative to present ideas/suggestions to management.
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned.

Benefits

• Medical, Dental and Vision Benefits for you and your family
• 401(k) with Company Match
• Company-paid Life Insurance and Disability Benefits
• Supplemental Insurance packages
• Paid Company Holidays
• Paid Time Off and Volunteer Time Off

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees