Specialist I, Prior Authorization

Navitus Health Solutions, LLC•,

3d•Remote

About The Position

Navitus Health Solutions is seeking a Specialist I, Prior Authorization to join their team. The Specialist I, Prior Authorization (PAS) will review, process, and troubleshoot incoming Prior Authorization requests for various medications. The Specialist I, Prior Authorization (PAS) will accurately process the requests according to regulatory and client specific guidelines. The PAS will work with other team members to meet the departmental performance metrics and maintain compliance. The PAS will work with clinical to ensure requests are processed accurately and timely. The PAS will process requests that come in via phone, fax, and web submission.

Requirements

A high school degree or equivalent.
Previous customer service experience required
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

Post high school education desired such as L.P.N., Certified Pharmacy Technician, Medical Terminology, or Medical Transcriptionist
Previous data entry experience preferred
Experience in health insurance/pharmacy insurance or managed care organization preferred
Prior authorization processing experience desired
Experience in a PBM or managed care call center desired
Experience in a mail or retail pharmacy setting desired
Experience with Medicare and/or Medicaid regulatory guidance desired

Responsibilities

Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit
Communicate prior authorization criteria to providers
Act as a provider help desk specialist to aid providers in submitting prior authorization requests, providing formulary product information, and communicating prior authorization request status
Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs
Participate in ad hoc or regularly scheduled Prior Authorization projects or projects for other Navitus departments
Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
Utilize work down time for personal and professional development through such activities eLearning classes, participation in the Navitus CPhT program, and by continually reviewing all available resources used in prior authorization processing
Maintain scheduled hours and demonstrate flexibility to aid in hour coverage
Other duties as assigned