Prior Authorization Representative
Orsini Healthcare•Elk Grove Village, IL
•$23•Hybrid
About The Position
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.
Requirements
- Experience with Major Medical Insurance.
- Knowledge of Pharmacy Benefit.
- Knowledge of HCPC Codes (J-Codes).
- Knowledge of ICD-10 Codes (Diagnoses Codes).
- Familiar with medical documentation such as H&P’s, Genetic testing, etc.
- Ability to read prescriptions.
- Ability to convert a prescription into an authorization request based on payer requirements.
- Ability to interpret medical policies.
- Proficiency in Microsoft Office (including Excel/TEAMS)
- Strong data entry and quality assurance skills with attention to detail
- Ability to multitask in a fast-paced environment
- Self-starter with strong organizational skills
Responsibilities
- Contact plans (PBM or Major Medical) to validate requests sent from BV
- Contact physician offices to obtain current prescriptions and required clinical documentation
- Validate that received clinical documentation meets plan requirements
- Initiate prior authorizations through CoverMyMeds and follow up on all pending PAs within 48 hours
- Respond to urgent requests from the Patient Care Coordinator Team or Program Manager in a timely manner
- Obtain approval and denial letters
- Submit new and re-authorizations through the Complex audit process
- Initiate re-authorizations 30 days prior to expiration
- Ability to meet daily key performance indicators (KPIs) in a fast-paced environment
- Strong attention to detail with a willingness to go the extra mile
- Ability to multitask and manage priorities effectively
- Flexibility to work overtime as needed
- Other duties as assigned
Benefits
- Medical Coverage, Dental, and Vision Coverage
- 401(k) with employer match
- Accident and Critical Illness coverage
- Company-paid life insurance options
- Generous PTO, paid holidays, and floating holidays
- Tuition reimbursement program.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
1-10 employees
