Prior Authorization Representative

ProCare Rx • Miramar, FL

23h • Onsite

About The Position

This role is responsible for managing incoming and outgoing calls, handling correspondence with pharmacies, physicians, and healthcare providers, and analyzing clinical Prior Authorizations (PA) using provided protocols. The representative will clarify questions, assist with inquiries, and document recommendations and decisions in online databases. The position requires delivering high-quality customer service in a fast-paced PA program, supporting new employee training, and participating in relevant business unit activities. A flexible work schedule is necessary to meet changing department needs.

Requirements

• Pharmacy technician certification (CPhT) required, registered preferred.
• Excellent communication skills working in a professional environment.
• Strong organizational skills working under time constraints in a constantly changing environment.
• PC experience to navigate new applications, with intermediate Excel and Word skills preferred.

Nice To Haves

• Prefer 2 years experience working as a pharm tech or as a physician office assistant handling phone calls and reviewing charts.
• 1 year experience contacting other healthcare providers as part of daily job preference.

Responsibilities

• Manage incoming and outgoing calls, documenting all calls in the dedicated application for call documentation.
• Handle letters from/to pharmacies, physicians, and healthcare providers in support of the Prior Authorization (PA) department.
• Analyze clinical PAs using the provided clinical protocols, and provide regarding PA requests based on provided documentation.
• Clarify any questions or concerns received from clients and/or internal departments.
• Assists with inquiries related to pre-authorizations referred by the account managers or other departments.
• Use online databases to document recommendations, clinical decisions, and responses.
• Deliver high-quality customer service in a fast-paced, dedicated PA program.
• Provide support on training new employees.
• Participate in training, conferences, orientations, and other activities related to your business unit.
• Must have a flexible work schedule to meet changing department needs.

Benefits

• Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Paid vacation and holiday pay.
• Employee Wellness Program.
• 401(k) with a company match.
• Employee Assistance Program.
• Employee referral program.

What This Job Offers

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