Lead Pharmacy Prior Authorization Coordinator

BrightSpring Health Services; Louisville (KY); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health insurance

STD/LTD

Tuition assistance

Employee discount

401k

PTO

Tuition reimbursement

Closed-door environment

Job summary

PharMerica is seeking a Pharmacy Lead Prior Authorization Coordinator to manage prior authorization workflow and collaborate with prescribers and facility contacts to secure therapy changes when insurance requires it. The role includes overseeing training and coordinating with Billing and Implementation teams.

The candidate will ensure timely approvals, participate in policy updates, and maintain compliance with government regulations while supporting a high standard of patient care in a

Qualifications

• High School Diploma or GED required.
• Pharmacy Tech License preferred.
• Excellent customer service and communication skills, both written and verbal.
• Ability to prioritize and meet pre-determined deadlines.
• Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills.
• Experience in healthcare billing environment (pharmacy preferred).
• Familiarization with online claims processing and Medicaid and Medicare billing practices.
• Proficient with Microsoft Word & Excel required.
• If a current PAL employee, you must: 6+ months of prior authorization experience as PAL Core Prior Authorization Coordinator; adhere to attendance policy; excel in core responsibilities; not be on any Performance Improvement Plan.

Responsibilities

• Helps manage staff appropriately and sets clear expectations for performance.
• Works with Billing Coordinator/Supervisor/Manager in researching pharmacy accounts requiring special attention.
• Assists Billing Coordinator/Supervisor/Manager in overseeing daily prior authorization activities per policies and procedures when necessary.
• Ensures appropriate, timely and professional communications with Implementation, Account Management, Directors of Pharmacy, and Facility staff as needed.
• Audits prior authorization functions regularly for compliance to policies, procedures, contract and government regulations.
• Prioritizes and delegates tasks to ensure timely completion.
• Follows HIPAA and government regulations.
• Participates in projects and/or management meetings.
• Addresses workflow and business issues while keeping direct manager informed.
• Participates on sub-groups to identify best practices and training material.

Skills

Customer service

Communication

Multitasking

Typing proficiency

Technical skills

Healthcare billing

Medicaid/Medicare billing

Word & Excel

Prior authorization

Education

High School Diploma/GED

Job description

Our Company

PharMerica

Overview

Join our PharMerica team!

PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!

Schedule: Mon-Fri(8:30am to 5pm)

This is a hybrid opportunity. Applicants must reside in, or commutable distance, to Louisville, KY

We offer:

• DailyPay
• Flexible schedules
• Competitive pay
• Shift differential
• Health, dental, vision and life insurance benefits
• Company paid STD and LTD
• Tuition Assistance
• Employee Discount Program
• 401k
• Paid-time off
• Tuition reimbursement
• Non-retail/Closed-door environment

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

*Position will be posted for a minimum of 7 business days

Responsibilities

The Pharmacy Lead Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or coordinating with prescribers and/or facility contacts to have therapy changed to a preferred alternative due to insurance not covering the treatment in question. The Pharmacy Lead PA Coordinator also oversees new hire training completed by the Prior Authorization Coordinator II.

• Helps manage staff appropriately and sets clear expectations for performance
• Works with Billing Coordinator/Supervisor/Manager in researching pharmacy accounts requiring special attention
• Assists Billing Coordinator/Supervisor/Manager in overseeing daily prior authorization activities per policies and procedures when necessary
• Ensures appropriate, timely and professional communications occurs with Implementation team, Account Management team, Directors of Pharmacy, and Facility staff as needed
• Audits prior authorization functions regularly for compliance to policies, procedures, contract and government regulations
• Prioritizes and delegates job tasks to ensure timely completion
• Follows all applicable government regulations including HIPAA
• Participates in projects and/or management meetings
• Addresses workflow and/or business issues while keeping direct manager informed
• Participates on various prior authorization specific sub‑groups to identify all attributes for best practice implementation and influences development of policies and procedures as well as identifies appropriate training material and educational opportunities
• Implements proper prior authorization forms and forwards them to physicians to obtain approval
• Completes change of therapy forms to facility contacts and physicians
• Adjudicates claims, researching formularies for numerous insurance plans, contacting physician’s office, updating spreadsheets on a daily basis, follow-up and obtain approval or denial of prior authorizations
• Communicates timely and in a courteous manner to the physician/clinical staff regarding authorization status or delays
• Oversees and approves updates made to the Prior Authorization Training Manuals by the Pharmacy Prior Authorization Coordinator II

Qualifications

• High School Diploma/GED required
• Pharmacy Tech License preferred
• Excellent customer service and communication skills, both written and verbal
• Ability to prioritize and meet pre-determined deadlines
• Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
• Experience in healthcare billing environment (pharmacy preferred)
• Familiarization with online claims processing and Medicaid and Medicare billing practices
• Proficient with Microsoft Word & Excel required
• If a current PAL employee, you must:
  • Have 6+ months of prior authorization experience as PAL Core Prior Authorization Coordinator
  • Adhere to Pharmacy Alternatives, LLC attendance policy
  • Excel and adhere to core Pharmacy Alternative Prior Authorization responsibilities
  • Not be on any form of Performance Improvement/Corrective Action Plan

About our Line of Business

PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.