Prior Authorization Coordinator

PharMerica•Jeffersontown, KY

6d•Onsite

About The Position

The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question. This role ensures accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts. The coordinator follows up on all claims requiring prior authorization within four to five business days, tracks and reviews all claims in QuickBase, and sends an excel tracking spreadsheet to the Director of Pharmacy on a weekly basis. They compare the system report of unbilled claims requiring prior approval to the QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on. Additionally, this role assists the Billing Department with resolving unbilled claims at each month-end close, advocates for clients as needed, and adjudicates and resolves claim rejections. The Prior Authorization Coordinator utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on a daily basis. Other responsibilities may be assigned.

Requirements

High School Diploma/General Education Diploma required
Excellent customer service and communication skills, both written and verbal
Ability to prioritize and meet pre-determined deadlines
Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
Experience in healthcare billing environment (pharmacy preferred)
Familiarization with on-line claims processing and Medicaid and Medicare billing practices
Proficient with Microsoft Word & Excel required

Nice To Haves

Kentucky Pharmacy Technician License preferred

Responsibilities

Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts
Follows up on all claims requiring prior authorization within four to five business days
Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis
Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on
Assists Billing Department with resolving unbilled claims at each month end close
Advocates for clients as needed
Adjudicates and resolution of claim rejections as needed
Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis
Other responsibilities as assigned