Pharmacy Authorization & Appeals Coordinator (Mon–Fri)

Hy-Vee; Omaha (NE); On-site; USD 26,000 - 28,000; Full time

Benefits offered by this job

Six paid holidays

Job summary

Amber Specialty Pharmacy in Omaha, NE, is seeking an Authorization Management Specialist. You will prepare appeal summaries, process prior authorizations, and communicate with prescribers, health plans, and patients to advance timely approvals.

The role requires proficiency with MS Excel/Word/Outlook, familiarity with Medicare/Medicaid and commercial coverage, and a commitment to maintaining accurate electronic medical records. This is a full-time, in-person position with daytime hours.

Qualifications

• High school diploma or equivalent required.
• Nationally Certified Pharmacy Technician preferred; certification application per state criteria.
• HIPAA training or ability to handle confidential information.
• Six months or less of related work experience.

Responsibilities

• Initiates and completes prior authorizations and appeals for specialty pharmacy.
• Works with providers, health plans, PBMs, and other pharmacies to relay information and provide service.
• Communicates with providers, health plans, PBMs, and patients to obtain PA/appeal status.
• Submits PA/appeal requests via electronic, phone, or fax for physicians/providers.
• Maintains PA documents and records accurately and timely.
• Evaluates claims rejected for PA following company policy.
• Advocates for patient coverage issues.
• Reviews patient chart notes and payer requirements to determine action.
• Ensures timeliness of PA requests and provider appeals per guidelines.
• Adheres to all company policies and Accreditation procedures.

Skills

MS Excel/Word/Outlook

Insurance verification

Communication

Self-initiative

Deadline-driven

Medicare/Medicaid knowledge

Prior authorizations

Claims troubleshooting

Reading medical records

Education

High school diploma or equivalent

Nationally Certified Pharmacy Technician preferred

Tools

EMR/EHR systems

Microsoft Outlook

Skype

Job description

Amber Specialty Pharmacy in Omaha, NE, is seeking an Authorization Management Specialist. You will prepare appeal summaries, process prior authorizations, and communicate with prescribers, health plans, and patients to advance timely approvals.

The role requires proficiency with MS Excel/Word/Outlook, familiarity with Medicare/Medicaid and commercial coverage, and a commitment to maintaining accurate electronic medical records. This is a full-time, in-person position with daytime hours.