Pharmacy Prior Authorization Specialist
About The Position
The Prior Authorization (PA) Specialist is responsible for all aspects of the prior authorization process while continuously monitoring and ensuring compliance through established procedures and documentation. Responsibilities include collecting all the necessary documentation, contacting the client for additional information to complete the PA process. Complete, timely, and accurate identification and submission of prior and retro authorization requests to payors. Interacts with clients, insurance companies, patients, as necessary, to request for prior authorizations. Responsible for documenting account activity, updating patient and claim information and demonstrates proficiencies with Epic, CoverMyMeds, and other billing platforms to ensure all functionalities are utilized for the most efficient processing of claims and identifies PA trends and/or issues resulting in delayed claims processing. Provides the highest level of customer service to internal care teams and patients and families.
Requirements
- High school graduate or G.E.D.
- Graduation from accredited pharmacy technician training program, or equivalent training.
- Minimum of three (3) years of retail or outpatient pharmacy practice experience.
- Licensed by the Washington State Pharmacy Department of Health as a pharmacy technician.
Nice To Haves
- One (1) year Seattle Children's Outpatient Pharmacy experience.
- Specialty Pharmacy and/or Centralized Prior Authorization Services knowledge.
Responsibilities
- Collecting all the necessary documentation for the prior authorization process.
- Contacting the client for additional information to complete the PA process.
- Completing timely and accurate identification and submission of prior and retro authorization requests to payors.
- Interacting with clients, insurance companies, and patients to request prior authorizations.
- Documenting account activity and updating patient and claim information.
- Demonstrating proficiencies with Epic, CoverMyMeds, and other billing platforms for efficient claims processing.
- Identifying PA trends and/or issues resulting in delayed claims processing.
- Providing the highest level of customer service to internal care teams and patients and families.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- 403(b)
- Life insurance
- Paid time off
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
