Pharmacy Prior Authorization Specialist

Appalachian Mountain Health; Asheville (NC); On-site; USD 45,000 - 65,000; Full time

Job summary

Appalachian Mountain Health is seeking a Pharmaceutical Prior Authorization Technician to manage the full PA process for medications and diagnostic imaging, utilizing multiple portals to obtain approvals and notify patients and providers. The role requires meticulous documentation, effective communication with insurers, and collaboration with care teams to gather information and resolve denials.

A background in pharmacy operations or prior authorization workflows is preferred, with a High School

Qualifications

• Background as a Pharmacy Technician, Medical Assistant or Prior Auth Technician (Referral Coordinator) is preferred.

Responsibilities

• Filling out prior authorizations in Cover My Meds
• Filling out prior authorization for Medicaid patients in NC Tracks
• Utilization of EviCore, Carelon, Evaility, Humana, RadMD and UHC as diagnostic imagine PA portals
• Contacting patients for additional information if necessary to complete the process
• Follow up with providers on missing information needed for the completion of each prior authorizations
• Follow up with Insurance companies and document conversations
• Reading and interpreting medical records to obtain the information necessary for prior authorization
• Closing the loop on all Prior Authorizations regardless of the outcome, which includes notifying patients, providers and pharmacies

Skills

Organized

Strong communication

Claims discussion

Documentation

Education

High School or GED

Tools

Cover My Meds

NC Tracks

EviCore

Carelon

Evaility

Humana

RadMD

UHC

Job description

Appalachian Mountain Health is seeking a Pharmaceutical Prior Authorization Technician to manage the full PA process for medications and diagnostic imaging, utilizing multiple portals to obtain approvals and notify patients and providers. The role requires meticulous documentation, effective communication with insurers, and collaboration with care teams to gather information and resolve denials.

A background in pharmacy operations or prior authorization workflows is preferred, with a High School