Pharmacy Prior Authorization Specialist

CommuniCare Health; Broadview Heights (OH); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Job summary

CommuniCare Health is seeking a Pharmacy Prior Authorization Specialist for a full-time remote role. This position involves managing the Prior Authorization workflow for facilities in states including Ohio and West Virginia. The successful candidate will submit prior authorizations, resolve discrepancies, and ensure compliance with federal and state regulations. Ideal for those with prior authorization or Long-Term Care pharmacy experience, offering comprehensive benefits including health insurance and a 401(k) match.

Qualifications

• Prior Authorization experience preferred, but not required.
• Previous Long-Term Care pharmacy experience is a plus.
• Knowledge of Framework LTC is a plus.

Responsibilities

• Maintain the Prior Authorization workflow for assigned facilities.
• Submit prior authorizations to respective plans.
• Work directly with insurance companies for resolution.

Job description

Pharmacy Prior Authorization Specialist page is loaded## Pharmacy Prior Authorization Specialistlocations: Pharmacy Solutions Group - Ohiotime type: Full timeposted on: Posted Todayjob requisition id: R-0000117054**Job Address:**9299 Market PlaceBroadview Heights, OH 44147**Job Description****:** Prior Authorization Specialist**Reports to****:** Pharmacy Prior Authorization Manager**Job Type****:** Full-Time – Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland**Position Overview****:** The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process.**Key Responsibilities Include but are not limited to****:*** Work in cohesion with the Adjudication, Claim Intervention and Billing Departments* Submit prior authorizations in accordance with Insurance regulations* Ensure accurate and timely processing of prior authorizations* Work directly with insurance companies for prior authorization resolution* Communicate with facilities to gain additional information* Any other duties assigned* Follow federal and state regulations* Adhere to company policies and procedures* Follow HIPPA guidelines and regulations**Qualifications and Requirements****:*** Prior Authorization experience (not required)* Previous Long-Term Care pharmacy experience a plus (not required)* Knowledge of Framework LTC a plus (not required)**Salary and Benefits****:*** Competitive salary commensurate with experience* Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more