Job Summary
This role focuses on overseeing prior authorization requests and appealing decisions made by insurance carriers. It includes the resolution of denied claims and assisting patients in acquiring medications that need authorization. The position necessitates collaboration with healthcare providers, including physicians and pharmacists, while also ensuring that records meet HIPAA compliance standards and tracking authorizations for updates.
Responsibilities
- Manage and process prior authorization requests and appeals effectively.
- Address and resolve rejected claims in a timely manner.
- Assist patients in obtaining necessary medications that require prior authorization.
- Coordinate with physicians, pharmacists, and various departments to ensure efficient workflows.
- Maintain accurate and compliant records of authorizations and renewals in accordance with HIPAA regulations.
Qualifications
- A high school diploma or GED is required.
- Minimum of one year experience in pharmacy or prior authorization roles.
- State Board of Pharmacy registration where applicable.
- Strong communication, organizational, and customer service abilities.
- Familiarity with pharmacy terminology, insurance claims processes, and programs such as CoverMyMeds.
- Preferred qualifications include an associate degree or PTCB certification and experience in specialty pharmacy.
