Prior Authorization Coordinator

JOB RESPONSIBILITIES

• Process authorizations electronically, utilizing PA and payer portals, fax or telephone working with payers to secure authorizations.


• Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.


• Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted authorizations.


• Maintain clear communication and documentation with provider offices, patients and pharmacy account managers.


• Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.


• Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.


• Verify the accuracy and quality of data entry within authorizations prior to submission.


• Ability to confirm whether a therapy is complete and if an authorization renewal is needed.


• Initiate and follow-up on authorization renewal requests as assigned.


• To safeguard, protect, and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and company policies/procedures.


• Assess, prioritize and resolve client issues using good listening and comprehension skills.


• Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.


• Assist Reimbursement Director in supervising, guiding, and continual training of PA Coordinators.


• Demonstrate working knowledge of all facets of the role, relevant regulations & organizational and departmental policies & procedures.


• Escalate issues to management as appropriate.


• Perform other duties as assigned to support the business.

QUALIFICATIONS AND REQUIREMENTS
Previous Experience:

• Strong understanding of medical terminology, insurance plans and authorization processes.


• Bilingual English/Spanish is a plus.


• Minimum 3 years of pharmacy or healthcare experience required.


• Minimum 1 year management experience of a team of 5 or more employees. 


• Working in a fast-paced environment for 3+ years is required.


• Ability to manage cases from multiple clientele programs and follow program business rules.


• Proficiency with data entry functions and Microsoft applications required.


• Ability to work independently and on a team.


• Excellent communication, problem solving and customer service skills.


• Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.


• Ability to use multiple PC monitors and navigate through several software systems effectively.

Education:

• High School Graduate required, College degree preferred.


• State Pharmacy Technician registration or PTCB National Certification preferred.

Physical Demands:

• Requires sitting, standing, and occasional light lifting.

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our recruitment team at [email protected]. 

ProCare Rx is an Equal Opportunity Employer.