Specialist I, Prior Authorization

Navitus Health Solutions, LLC • ,

3d • $20 - $23 • Remote

About The Position

Lumicera Health Services is defining the “new norm” in specialty pharmacy to optimize patient well-being through our core principles of transparency and stewardship. Here at Lumicera, our team members work in an environment that celebrates creativity and fosters diversity. 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED