Prior Authorization Specialist - Hybrid

Orsini Healthcare • Elk Grove, IL

134d • $19 - $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

Responsibilities

• Contact plans (PBM or Major Medical) to validate request sent from BV
• Contact physician's office to obtain current prescriptions
• Contact physician's office to obtain clinical documentation that is required by the plans
• Validate that the clinical documentation received is what is required by the plan
• Initiate prior authorizations through Cover My Meds
• Follow up on all pending PA's within 48 hours
• Respond to urgent emails submitted by the Patient Care Coordinator Team or Program Manager in a timely manner
• Obtain approval / denial letters
• Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process
• Initiate re-authorizations that are set to expire 30 days prior to the term date

Benefits

• BCBSL Medical
• Delta Dental
• EyeMed Vision
• 401k
• Accident & Critical Illness
• Life Insurance
• PTO, Holiday Pay, and Floating Holidays
• Tuition Reimbursement

What This Job Offers

• Industry: Ambulatory Health Care Services