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 patients 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

ProCare Rx is an Equal Opportunity Employer.

Required Experience:

IC