Certified Pharmacist (Prior Authorization)
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Job Location:
Quezon City - Philippines
Monthly Salary:
Not Disclosed
Posted on:
02-11-2025
Vacancies:
1 Vacancy
Department:
Job Summary
EOR: One Workforce Global
Employment Type: Full-Time Employment
Work Setup: 100% Onsite (Office location in either Eastwood Clark or Muntinlupa)
Work Schedule: Night Shift (Following U.S. Central Time Zone)
Duties and Responsibilities:
- Intake and triage PA requests from providers pharmacy and patients; confirm eligibility and benefits.
- Gather required clinical information (diagnosis labs previous therapies step-therapy/QL/ST documentation).
- Prepare and submit PA requests via PBM/payer portals eFax or phone (e.g. CoverMyMeds NaviNet payer sites).
- Track cases to decision; proactively follow up on pending requests and expiring authorizations.
- Document all activities and outcomes in the EHR/pharmacy system and workflow tracker; maintain queue SLAs.
- Communicate decisions to patients and prescribers; coordinate next steps with dispensing/specialty pharmacy.
- For denials collect missing info and prepare first-level appeals or redeterminations per policy.
- Maintain current knowledge of plan formularies UM criteria Medicare Part D Medicaid and commercial payer rules.
- Protect PHI and follow HIPAA company policies and quality standards
Job Requirements:
- Active RPH License is preferred.
- Prior Authorization experience for at least 4 years is required.
- Experience working in the pharmacy setting is a must.
- Versed in NextGen and Prior Authorization software (ex. CoverMyMeds) is a plus.
- Detail-oriented with strong organizational skills
- Ability to follow SOPs and meet deadlines
- Excellent verbal and written communication skills
- Excellent interpersonal and customer service skills
- Excellent organizational skills and attention to detail
- Excellent time management skills with a proven ability to meet deadlines
- Strong analytical and problem-solving skills
- Ability to prioritize tasks
- Ability to function well in a high-paced and at times stressful environment
WHY INTELASSIST
We grow together. We value your effort. We aim to empower you.
Key Skills
- LTC Pharmacy
- Hospital Experience
- Pharmacy Software
- Continuous Improvement
- Go
- Infusion Experience
- Pharmacy Residency
- Training & Development
- Order Entry
- Epic
- Clinical Pharmacy Experience
- Compounding Medications
About Company
: Work collaboratively with a team to ensure the complete and timely collection of medical records, billing information, and other materials collected on behalf of our customers (Law Offices).Qualifications as follows: Excellent Communication Skills (Oral and Written)Ability to exp
