Job Address:

9299 Market Place
Broadview Heights, OH 44147


 

Job Description: Prior Authorization Specialist

Reports to: Pharmacy Prior Authorization Manager

Job Type: Full-Time – Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland

Position Overview: The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process.

Key Responsibilities Include but are not limited to:

• Work in cohesion with the Adjudication, Claim Intervention and Billing Departments
• Submit prior authorizations in accordance with Insurance regulations
• Ensure accurate and timely processing of prior authorizations
• Work directly with insurance companies for prior authorization resolution
• Communicate with facilities to gain additional information
• Any other duties assigned
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Qualifications and Requirements:

• Prior Authorization experience (not required)
• Previous Long-Term Care pharmacy experience a plus (not required)
• Knowledge of Framework LTC a plus (not required)

Salary and Benefits:

• Competitive salary commensurate with experience
• Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more