Prior Authorization Specialist
Hiring Manager Notes:
- M-F 11a-8p
- $16-$19
- At least 1-2 years of insurance verification
- FULL PA process- obtaining the PA form, filling it out, calling dr. office and obtaining lab and cart notes.
- Pharmacy background a good plus
- Eligibility verification/investigation experience
- Well spoken
Position Summary:
Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice.
Essential Functions:
- Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
- Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
- Obtain prior authorizations; initiate requests, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization.
- Facilitate appeals process between the patient, physician and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative document with patient and physician office.
- Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial status.
Additional Information
All your information will be kept confidential according to EEO guidelines.