Pharmacy Prior Authorization Coordinator II- Remote in VA OR FL!

Sentara Health; Orlando (FL); Remote; USD 45,000 - 75,000; Full time

Job summary

Join an innovative healthcare provider as a Pharmacy Prior Authorization Coordinator II, where you will support the operations of a dynamic call center. This role is perfect for those with a passion for customer service and a background in pharmacy, as you will assist members and providers with prior authorizations and pharmacy benefits. With a focus on high member satisfaction, you will utilize your expertise to resolve inquiries and mentor staff. Enjoy a fully remote position with a leading health organization that offers a comprehensive benefits package, including medical, dental, and career advancement opportunities. Make a meaningful impact in the healthcare field while enjoying the flexibility of remote work.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Tuition Reimbursement

401k/403B

Performance Plus Bonus

Career Advancement Opportunities

Work Perks

Qualifications

• 2 years of Pharmacy Call Center or Authorization experience required.
• Knowledge of pharmacy related applications is essential.

Responsibilities

• Support day-to-day operations for call center and prior authorization cases.
• Resolve member/provider issues and inquiries focusing on satisfaction.

Skills

Customer Service

Problem Solving

Communication

Education

Certified Pharmacy Technician (CPhT)

Tools

Pharmacy Computer System

Job description

Pharmacy Prior Authorization Coordinator II- Remote in VA OR FL!

Overview

Location: Fully remote in Virginia OR Florida!

Status: Full-time, permanent position (40 hours)

Work hours: 8am to 5pm, EST

Job Description Summary:

• Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial).
• Provides knowledgeable and courteous customer service and response to members and providers.
• Handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution.
• Uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist.
• Serves as a resource and mentor to pharmacy staff and assists TC with workflow oversight for the pharmacy call center and prior authorization operational teams.
• Assists with special projects and assignments and maintains above average knowledge of all pharmacy related applications to assist in workflow performance.
• Serves as an internal resource interfacing with members, providers, and internal staff to resolve escalated pharmacy claims and prior authorization issues.
• Owns the effective resolution of member or provider issues, complaints, and inquiries, focusing on high member satisfaction.

Required Qualifications:

• 2 years of Pharmacy Call Center or Authorization experience REQUIRED

Preferred Qualifications:

• 2 years of Managed Care, Health Plan or PBM experience preferred
• Certified Pharmacy Technician (CPhT) - Certifications - Pharmacy Technician Certification Board (PTCB)/ National Healthcareer Association (NHA)

Benefits:

Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

About Sentara Health Plans:

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-72594