Pharmacy Prior Authorization Specialist
CommuniCare Health Services
•Remote
About The Position
The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process.
Requirements
- Prior Authorization experience (not required)
- Previous Long-Term Care pharmacy experience a plus (not required)
- Knowledge of Framework LTC a plus (not required)
Responsibilities
- Work in cohesion with the Adjudication, Claim Intervention and Billing Departments
- Submit prior authorizations in accordance with Insurance regulations
- Ensure accurate and timely processing of prior authorizations
- Work directly with insurance companies for prior authorization resolution
- Communicate with facilities to gain additional information
- Any other duties assigned
- Follow federal and state regulations
- Adhere to company policies and procedures
- Follow HIPPA guidelines and regulations
Benefits
- health insurance
- dental insurance
- vision insurance
- 401(k) with company match
- paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
