Prior Authorization Representative

ProCare Rx Career • Gainesville, GA

2d • Onsite

About The Position

The Prior Authorization Representative will manage incoming and outgoing calls, documenting all interactions in the dedicated application. This role involves handling correspondence with pharmacies, physicians, and healthcare providers to support the Prior Authorization (PA) department. Responsibilities include analyzing clinical PAs using provided protocols, offering recommendations on PA requests based on documentation, and clarifying questions from clients and internal departments. The representative will also assist with pre-authorization inquiries, use online databases for documentation, and deliver high-quality customer service in a fast-paced PA program environment. Additionally, the role includes supporting the training of new employees and participating in relevant business unit activities. A flexible work schedule is required to accommodate 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.

Nice To Haves

• 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.
• Intermediate Excel and Word skills preferred.

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