Prior Authorization Specialist
- Maintaining complete, timely and accurate documentation of all approvals and denials, and transferring all clinical questions and judgment calls to the pharmacist.
- Assist physician groups in initiating prior authorization, follow up with PBM, and initiate appeals if applicable.
- Assist with other duties such as outbound calls, monitoring/responding to inquiries and other duties as assigned by the Patient Services manager.
- Manages work volume from inception to delivery utilizes appropriate courteous and professional behavior based upon established standards
- Complies with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
- Manage written or formal documentation to patients and provider on prior authorization status.
- Communicates with Patient Care Coordinators and other internal teams for timely resolution of appeals/exceptions.
- General administrative support as assigned by manager.
- Provide backup support to team members as needed.
- Requires a high school diploma or equivalent
- 1 year experience
- Registered Pharmacy Technician
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