Responsibilities:

• Process pharmacy claims accurately and timely to meet client expectations
• Triage rejected pharmacy insurance claims to ascertain patient pharmacy benefits coverage
• Assist in the initiation of new prior authorization requests to providers
• Identify the correct prior authorization form required for the patient's insurance provider
• Coordinate with prescribers and medical offices to ensure applicable information is translated onto prior authorization forms
• Follow up with medical offices to check the status of prior authorization requests
• Assist with communicating the status of prior authorizations to both patients and providers
• Coordinate with medical offices to handle Appeals
• Respond to internal questions from other departments related to prior authorization requests
• Maintain compliance with patient assistance program guidelines
• Document all information and data discovery according to operating procedures
• Research required information using available resources
• Maintain confidentiality of patient and proprietary information

Requirements:

• High school diploma or GED required, Bachelor's degree (preferred)
• One year of Healthcare (Pharmacy preferred) experience, having resolved third party claims
• Strong verbal and written communication skills
• Sound technical skills, analytical ability, good judgment, and strong operational focus
• A passion for providing top-notch patient care
• Ability to work with peers in a team effort and cross-functionally
• Strong technical aptitude and ability to learn complex new software