Prior Authorization Coordinator

ProCare Rx•Gainesville, GA

11h

About The Position

JOB 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. QUALIFICATIONS AND REQUIREMENTS Previous Experience: Strong understanding of medical terminology, insurance plans and authorization processes. Bilingual English/Spanish is a plus. 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. Education: High School Graduate required, College degree preferred. State Pharmacy Technician registration or PTCB National Certification preferred. Physical Demands: Requires sitting, standing, and occasional light lifting. ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our recruitment team at [email protected]. ProCare Rx is an Equal Opportunity Employer.

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.