Prior Authorization Coordinator

ProCare Rx

19h•Onsite

About The Position

The Prior Authorization Coordinator is responsible for processing authorizations electronically, utilizing PA and payer portals, fax, or telephone. This role involves working with payers to secure authorizations, processing fax queues and emails, answering incoming calls, and adhering to all thresholds for authorization management. The coordinator will contact patient insurance companies to verify coverage, initiate authorizations, provide clinical documentation, and follow up on previously submitted authorizations. Maintaining clear communication and documentation with provider offices, patients, and pharmacy account managers is crucial. The role also involves working closely with provider office points of contact to obtain updated information for appeals and drafting letters, as well as following pharmacy workflow steps for a streamlined appeal process. Accurate data entry into the CRM system, verification of data accuracy, and confirming therapy completion or renewal needs are key duties. The coordinator will initiate and follow up on authorization renewal requests, safeguard protected health information in accordance with HIPAA laws and company policies, and assess/prioritize client issues. Cooperation with co-workers for coverage and assisting the Reimbursement Director in supervising and training PA Coordinators are also part of the responsibilities. A working knowledge of the role's facets, relevant regulations, and organizational/departmental policies is expected, along with escalating issues to management as appropriate and performing other assigned duties.

Requirements

Strong understanding of medical terminology, insurance plans and authorization processes.
Minimum 3 years of pharmacy or healthcare experience required.
Minimum 1 year management experience of a team of 5 or more employees.
Working in a fast-paced environment for 3+ years is required.
Ability to manage cases from multiple clientele programs and follow program business rules.
Proficiency with data entry functions and Microsoft applications required.
Ability to work independently and on a team.
Excellent communication, problem solving and customer service skills.
Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.
Ability to use multiple PC monitors and navigate through several software systems effectively.
High School Graduate required.

Nice To Haves

Bilingual English/Spanish is a plus.
College degree preferred.
State Pharmacy Technician registration or PTCB National Certification preferred.

Responsibilities

Process authorizations electronically, utilizing PA and payer portals, fax or telephone working with payers to secure authorizations.
Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.
Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted authorizations.
Maintain clear communication and documentation with provider offices, patients and pharmacy account managers.
Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.
Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
Verify the accuracy and quality of data entry within authorizations prior to submission.
Ability to confirm whether a therapy is complete and if an authorization renewal is needed.
Initiate and follow-up on authorization renewal requests as assigned.
To safeguard, protect, and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and company policies/procedures.
Assess, prioritize and resolve client issues using good listening and comprehension skills.
Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.
Assist Reimbursement Director in supervising, guiding, and continual training of PA Coordinators.
Demonstrate working knowledge of all facets of the role, relevant regulations & organizational and departmental policies & procedures.
Escalate issues to management as appropriate.
Perform other duties as assigned to support the business.