Prior Authorization Coordinator I

MedImpact Healthcare Systems, Inc.•Tempe, AZ

5d•$18 - $27•Onsite

About The Position

The Prior Authorization Coordinator I works as a member of the Prior Authorization Operations team, processing prior authorization requests according to accuracy, timeliness, productivity, and client performance standards. The coordinator uses business applications and drug references to gather information, enter and prioritize requests, review formulary alternatives and medication history, and document determinations. Using clinical protocols and client guidelines, the coordinator identifies missing information and routes requests for approval, pending status, or clinical review as appropriate. The role works under general supervision, with oversight varying according to demonstrated skill and performance, and is part of a three-level career path. The coordinator communicates with members, physicians, pharmacies, clients, clinical pharmacists, and internal teams to obtain information, manage pending requests, convey determinations, resolve inquiries, and support quality service. The position requires protecting confidential member and authorization information and following established protocols for handling related forms and records. Work is typically Monday through Friday, 8:00 a.m. to 5:00 p.m., with overtime and availability for nights, weekends, or holidays as business needs require. The role is on-site at the San Diego headquarters or another company location, with remote work possible with management approval based on business requirements.

Requirements

GED or high school diploma and at least 1 year of experience, or an equivalent combination of education and experience.
Intermediate knowledge of Microsoft Office, including Word, Excel, and Outlook, and aptitude for learning new programs.
Experience with Windows-based database programs.
Successfully complete one of the national certification exams or obtain state licensure in any U.S. state.
Maintain a current, unrestricted Pharmacy Technician License and/or CPhT certification.
Ability to interpret instructions provided in written, oral, diagram, or schedule form; define problems, collect data, establish facts, and draw valid conclusions.
Ability to perform basic arithmetic and calculate rates, ratios, and percentages, interpret bar graphs, and apply fractions, percentages, ratios, and proportions to practical situations.
Ability to present information effectively in one-on-one and small-group settings; read and comprehend simple instructions and short correspondence; and write simple correspondence.

Responsibilities

Process and finalize prior authorization requests within client turnaround times and performance guarantees, following applicable guidelines.
Enter and prioritize prior authorization requests; check formulary alternatives and tried-and-failed medications; use drug references to verify whether requested drugs are indicated and approved for the condition; and document approval or non-approval information.
Respond to status requests by faxing information to physicians or pharmacies.
Follow the defined boundaries between administrative prior authorization processing and clinical decision-making, partnering with assigned clinical pharmacists as needed.
Meet prior authorization processing productivity and accuracy standards.
Analyze, research, and resolve processing issues appropriate to experience and career-path level; contact clients, members, physicians, or pharmacies for information; consult subject matter experts or a supervisor; and refer unique or high-dollar requests to a supervisor according to guidelines.
Coordinate notifications to members, physicians, and pharmacies to obtain missing information, manage pending requests, and communicate determinations; document request information and status; and make outbound calls to obtain information and answer status questions.
Collaborate with MCO and self-insured client teams to understand processing requirements and expectations and, as appropriate to career-path level, support special processing projects and client claim inquiries.
Collaborate with Contact Center Services to resolve prior authorization inquiries.
Handle provider, pharmacy, and member calls to complete prior authorization and peer-to-peer requests according to client-specific requirements.
Protect the confidentiality and privacy of prior authorization and member information, including following protocols for date stamping and the storage and security of forms and related information.