Prior Authorization Coordinator

National Healthcare Solutions Group LLC • US,

7d

About The Position

This position is responsible for accurately processing prior authorizations in the prior authorization software, primarily finalizing PA determinations with data entry as needed. This position requires the employee to provide quality customer service to internal and external customers via e-mail or phone correspondence. The successful prior authorization coordinator is a detail-oriented, strong communicator and is an organized problem solver. Able to work independently and collaboratively with internal team members and external plan participants. Must be results-oriented with a positive attitude and able to manage time skillfully.

Requirements

• Minimum of 2 years’ experience in PBM or related (retail or hospital pharmacy)
• Ability to work cooperatively
• Ability to master computer/software applications necessary for completing job tasks as required.
• Ability to understand functionality of applications for processing PA reviews (data entry).

Nice To Haves

• C.Ph.T license desired

Responsibilities

• Assist with calls transferred from Member Service Representatives (MSRs) for prior authorization-related issues; research and resolve questions from members, providers, pharmacies, and other callers, including explaining PA denials.
• Document callers’ questions, issues, and resolution in the CRM (Dynamics).
• Send outbound PA request forms via fax to provider offices to initiate prior authorizations and follow up by phone as needed to obtain required clinical documentation.
• Respond to emails to initiate prior authorizations and address PA status inquiries from internal and external stakeholders (e.g., providers, members, internal teams).
• Finalize PA orders following clinical review by a Pharmacist or PA Technician, documenting the decision in the CRM (Dynamics) and entering overrides upon approval.
• Monitor assigned queue(s) and case volume to help meet turnaround time (TAT) targets.
• Meet and/or exceed production, quality, attendance, and adherence standards.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed