Prior Authorization Representative
About The Position
Careers with real impact. Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter. ABOUT ORSINI Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™ OUR MISSION Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™. CORE VALUES At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.
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
