Specialty Prior Authorization Coordinator

WellDyne • Lakeland, FL

1d • Onsite

About The Position

The Prior Authorization Coordinator is responsible for obtaining and renewing authorizations for medical and/or pharmacy payors. Additional responsibilities include preparing paperwork and documentation required for billing and collections and working with other departments as necessary to facilitate accurate and timely payment of claims.

Requirements

• High School Diploma or equivalent
• Demonstrates a high degree of personal responsibility regarding accuracy and quality of work.
• Demonstrates ability to work effectively and maintain expected productivity.
• Ensures accuracy of information being provided to Management for review.
• Schedules own time based on priorities.
• Demonstrates Excellent customer service and Professionalism
• Ability to multi-task
• Ability to communicate effectively, patiently and courteously.
• Ability to work in a high pace, stress environment.
• Should be independent and self-motivated.
• Maintains a good attendance record.

Nice To Haves

• Meet state requirements of national certification (CPhT) or other board approved training program, if required by state.
• Previous Prior Authorization and Claims experience is preferred

Responsibilities

• Initiates Prior Authorizations, Pre-Certifications, Pre-Determinations and Advanced Benefit Determination requests for new and existing patients.
• Performs pharmacy test claims and follow-up regarding results.
• Work on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance.
• Work with physician offices to facilitate the process of obtaining prior authorization from third party payers in order to maximize patients' access to treatment.
• Help support the appeal process to overturn insurance denials and/or benefit exclusions when needed.
• Works with Intake, Billing and Collection teams to resolve claims issues.
• Maintains confidentiality of all PHI in compliance with state and federal law.
• Other duties may be assigned.

What This Job Offers

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