Job Summary
The primary role involves overseeing pharmacy prior authorization requests and appeals in collaboration with insurance providers. This position focuses on resolving rejected claims to ensure that patients can access their prescribed medications. The individual will liaise with healthcare professionals while ensuring compliance with HIPAA regulations and tracking authorizations for their renewal.
Responsibilities
- Manage prior authorization requests and appeals with insurance carriers.
- Resolve rejected claims to facilitate patient access to medications.
- Collaborate with physicians, pharmacists, and other departments.
- Maintain records that adhere to HIPAA guidelines.
- Monitor the renewal process for authorizations.
Qualifications
- High school diploma or GED is required.
- Minimum of one year of pharmacy or prior authorization experience.
- State Board of Pharmacy registration as required.
- Knowledge of pharmacy terminology, insurance claim processes, and Medicare/Medicaid systems.
- Experience with claim rejection resolutions and coordination of benefits.
- Familiarity with NDC billing and CoverMyMeds.
- Preferred qualifications include an associate degree or PTCB certification and experience in specialty pharmacy.
Onco360 provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
