Pharmacy Prior Authorization Specialist

Job Address: 9299 Market Place Broadview Heights, OH 44147 Job Description : Prior Authorization Specialist Reports to : Pharmacy Prior Authorization Manager Job Type : Full-Time – Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland Position Overview : The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients.

He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process.

Key Responsibilities Include

Work in cohesion with the Adjudication, Claim Intervention and Billing Departments Submit prior authorizations in accordance with Insurance regulations Ensure accurate and timely processing of prior authorizations Work directly with insurance companies for prior authorization resolution Communicate with facilities to gain additional information Any other duties assigned Follow federal and state regulations Adhere to company policies and procedures Follow HIPPA guidelines and regulations Qualifications and Requirements : Prior Authorization experience (not required) Previous Long-Term Care pharmacy experience a plus (not required) Knowledge of Framework LTC a plus (not required) Salary and Benefits : Competitive salary commensurate with experience Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more