Orsini Healthcare - Elk Grove, IL

posted about 1 month ago

- Entry Level
Remote - Elk Grove, IL
Ambulatory Health Care Services

About the position

Orsini Specialty Pharmacy is a leader in rare disease and gene therapy pharmacy solutions, dedicated to simplifying how patients connect to advanced medicines. Our mission is to be the essential partner for biopharma innovators, healthcare providers, and payers, ensuring that patients and their families have access to revolutionary treatments for rare diseases. We provide a comprehensive range of services including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider. Our core values, encapsulated in the LIVE IT principles, guide our commitment to excellence, collaboration, and genuine care in every aspect of our work.

Responsibilities

  • Contact plans (PBM or Major Medical) to validate requests sent from BV.
  • Contact physician's office to obtain current prescriptions.
  • Contact physician's office to obtain clinical documentation required by the plans.
  • Validate that the clinical documentation received meets the requirements of the plan.
  • Initiate prior authorizations through Cover My Meds.
  • Follow up on all pending prior authorizations within 48 hours.
  • Respond to urgent emails submitted by the PCC 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.

Requirements

  • Experience with Major Medical Insurance.
  • Knowledge of Pharmacy Benefit.
  • Knowledge of HCPC Codes (J-Codes).
  • Knowledge of ICD-10 Codes (Diagnoses Codes).
  • Familiarity 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.
  • Prior pharmacy experience preferred.

Benefits

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