Prior Authorization Representative | Pharmacy Account

DME Service Solutions; Taguig; On-site; PHP 420,000 - 540,000; Full time

Benefits offered by this job

Apprenticeship Program

Employee Assistance Program

Job Training

Professional Development

Maternity & Paternity Leave

Sick Leave

Solo Parent Leave

Special Leave for Women

Vacation Leave

Job summary

DME Service Solutions in Taguig, Philippines is seeking a Prior Authorization Representative for the Pharmacy Account. This on-site role supports the RPPA team in submitting electronic prior authorizations, handling about 700 requests per day, and ensuring timely turnaround within service levels.

Ideal candidates have 2–3 years in retail pharmacy and experience with Epic and electronic prior auth tools (CoverMyMeds, SureScripts).

Qualifications

• 2-3 years retail pharmacy experience
• Retail Pharmacy electronic prior auth experience
• Experience working in Epic

Responsibilities

• Process prior authorizations within Epic and Surescripts as required
• Use CoverMyMeds to support ePA processing
• Communicate denials to clinic staff and maintain turnaround times
• Follow up on e-PA requests due to denials or missing information
• Make calls to payors or use payor portals as required

Skills

Epic

Tools

CoverMyMeds

SureScripts

Epic

Job description

Prior Authorization Representative | Pharmacy Account

DME Service Solutions

On-site - Taguig 1-3 Yrs Exp High/Senior High School Full-time

Employee Recognition and Rewards

Government Mandated Benefits

Insurance Health & Wellness

Professional Development

• Apprenticeship Program
• Employee Assistance Program
• Job Training
• Professional Development

• Maternity & Paternity Leave
• Sick Leave
• Solo Parent Leave
• Special Leave for Women
• Vacation Leave

Job Brief: We are looking for staff augmentation services within the Retail Pharmacy Prior Authorization (RPPA) Team and the clinic liaison teams. The goal of this initiative is to support the onshore RPPA team and liaison teams in the submission of electronic prior authorizations. This team handles an average volume of 700 pharmacy benefit electronic prior authorizations request per day. The team adheres to a service level agreement, ensuring submissions are completed within 30 minutes of receiving the request.

Key Responsibilities

• Working within Epic and Surescripts ePA to process prior authorizations.
• Working in Epic and CoverMyMeds as needed to process prior authorizations.
• Communicating denials to clinic staff within Epic Telephone Encounter.
• Maintaining quality standards and turnaround times.
• Follow up on e-PA’s due to denials or missing information.
• Calls to payor as required (or) use payor portals as required.

Required Skills

• Experience working in Epic

Required Education and Experience

• 2-3 years retail pharmacy
• Retail Pharmacy electronic prior auth experience

Experience Working In Epic Tool: CoverMyMeds Tool: SureScripts

Working Location

27th Floor Twenty-Four Seven McKinley, McKinley Pkwy & 24th St, Post Proper Northside, Taguig, Metro Manila, Philippines

Melugrace Yuson

HR Manager DME Service Solutions