Prior Authorization Specialist (Hybrid)

Orsini Healthcare•Elk Grove Village, IL

1d•$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, covert prescriptions into authorizations, and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician's offices to validate prescriptions, obtain clinical documentation, and initiative 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