Prescription Prior Authorization Specialist

Ideal Option; United States; Remote; USD 39,000 - 48,000; Full time

Benefits offered by this job

Medical, vision, dental

Short-term and long-term disability

Life insurance

Employee Assistance and Life programs

401K retirement program

Pet Insurance

PTO and holidays

Job summary

Ideal Option is a remote-friendly clinic network seeking a Prescription Prior Authorization Specialist to ensure prescriptions are covered by insurance. You will submit prior authorizations, verify coverage, and maintain documentation to support timely patient care and cost-effective medications.

The role requires strong communication skills, proficiency in Excel, and experience with eClinicalWorks. A High School Diploma or GED and familiarity with HIPAA/42 CFR Part 2 are essential.

Qualifications

• Effective verbal and written communication skills.
• Proficient in Excel.
• Ability to multitask and learn quickly in a fast-paced setting.

Responsibilities

• Submits prior authorizations to insurers by phone, fax and electronic systems.
• Verifies insurance coverage and formularies to ensure prescription payments.
• Maintains accurate documentation of prior authorizations.
• Coordinates with insurers, pharmacies and providers to resolve authorization issues.
• Responds to patient questions about authorization status.

Skills

Verbal communication

Written communication

Multitasking

Excel proficiency

PHI/HIPAA knowledge

Ability to work in fast-paced setting

Education

High School Diploma or GED

Tools

eClinicalWorks

Job description

Type: Temporary Role

Location: Remote

Compensation: $18.50

Ideal Option has been working on the front lines of the opioid epidemic since our first clinic opened in 2012. With more than 80 clinics across 9 states, we continuously strive to be the nation's leading provider of low-barrier evidence-based treatment for opioid use disorder. We are looking for a Prescription Prior Authorization Specialist to join our growing team and help us in our vision to give back lives, reunite families, and heal communities that are suffering from the devastating effects of substance use disorder.

We value our patients and our employees! We treat our employees like we would want to be treated ourselves: with respect and compassion. Below are some specifics on what Ideal Option offers and the role.

Benefits:

At Ideal Option, we offer our employees a competitive and comprehensive benefits program to recognize how important you are to the company. Current benefits include:

• Medical, vision, and dental
• Short-term and long-term disability options
• Life insurance
• Employee Assistance and Life Assistance programs
• A 401K retirement program
• Pet Insurance
• Paid time off and paid holidays

The Role:

As a Prescription Prior Authorization Specialist, you play a key role in ensuring our patients prescriptions will be covered by their insurance. We submit prior authorizations as needed to enable patients to pick up the correct prescription in a timely and cost-effective manner. Additional responsibilities include:

• Utilizes and comprehends eClinicalWorks. Such as: telephone encounters, chart notes, and provider directives.
• Ensures payment of prescriptions by verifying insurance coverage and prescription formularies.
• Submits prior authorizations to insurance companies via phone, fax and electronic systems. Answers incoming calls and addresses patients concerns and/or questions regarding their authorization process. Maintains accurate documentation of authorizations.
• Works directly with insurance companies, pharmacies, and providers. Monitors and tracks established patient prescription authorizations.
• Ensures payments of prescriptions by verifying insurance coverage and prescription formularies.
• Processes incoming calls and addresses patient concerns and/or questions regarding their authorization status.
• Works directly with insurance companies and pharmacies on resolving authorization issues.
• Maintains accurate documentation of prior approvals.
• Works closely with providers, Ideal Option staff and pharmacies to ensure the best patient care.
• Represents Ideal Option professionally and with a positive attitude.
• Complies with national PHI laws including HIPAA and 42 CFR Part 2.
• Maintains continual sustained attendance
• Other duties as assigned by supervisor.

Our ideal candidate:

Has effective verbal and written communication skills, is proficient in excel, has the ability to multitask, learn quickly and work in a fast paced environment. Has a knowledge of chemical dependency and its effects on individuals, families, and communities is required.

Requirements

Minimum Requirements:

• High School Diploma or GED.
• Experience with personal computers (word processing and/or electronic spreadsheets)
• Preferably one year or more of experience in office work.