Senior Pharmacy Prior Authorization Representative

Job Description: • Obtain initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies via portal, phone, and fax • Follow up on initial and renewal authorizations in a timely manner • Interface with other departments and identify medical documentation supporting prior authorization requests • Notify patients, prescribers, and internal teams of insurance denials and appeals processes • Confirm plan eligibility and process test claims • Calculate required units and quantity versus day supply • Prioritize and complete assigned tasks on schedule • Respond to chat and email update requests timely • Relay problems, concerns, questions, and ideas through appropriate communication lines • Maintain expected productivity and work effectively • Meet quality standards and demonstrate reliability and follow-through • Communicate effectively and express ideas clearly • Perform in accordance with system-wide competencies and behaviors • Perform other duties as assigned Requirements: • HS diploma or GED required • 2+ years of prior authorization, insurance verification or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required • Knowledge of medical terminology required • Knowledge of payer websites, eligibility, and coordination of benefits required • Knowledge of plan formularies and authorization requirements required • Knowledge of pharmacy vs medical payers and authorization required • Proficient computer skills and Microsoft Office Products required • Computer literacy, including Windows and MS Office Suite (Outlook, Word, and Excel) • If working at home occasionally or permanently, internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload Benefits: • Remote work arrangement • Work-from-home internet service requirement with minimum speeds of 10Mbps download/5Mbps upload • Tobacco-free policy and smoking cessation program eligibility where applicable