Prior Authorization & Appeals Specialist (Mon–Fri)

Amber Specialty Pharmacy; 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 seeks a Dedicated Authorization Management Specialist in Operations to handle prior authorizations and appeals, communicate with providers and payers, and document activity in EMR systems.

This office-based role requires strong MS Excel/Outlook skills, healthcare industry knowledge, and the ability to meet tight deadlines. Hours are Monday–Friday, 8 a.m.–5 p.m. CST, with no weekend shifts.

Qualifications

• High school diploma or equivalent.
• HIPAA trained and/or the ability to handle confidential information.
• Six months or less of similar or related work experience.

Responsibilities

• Initiates and completes prior authorizations and appeals for specialty pharmacy for all patients of an assigned product program.
• Work directly with providers, health plans, PBMs, and other specialty pharmacies to relay vital information and provide a high level of service.
• Communicates with providers, health plans, PBMs, Pharma partners, and patients to obtain status of pending prior authorizations and appeals.
• Submits prior authorization and/or appeal requests via electronic, phone or fax on behalf of physicians/providers as allowed.
• Assures that all prior authorization and appeal documents, databases, and records are maintained accurately and timely.
• Collaborates with program team members on other aspects of the product program, not limited to intake and patient access functions and patient communications and onboarding.
• Advocates on the patient's behalf to identify and assess coverage issues.
• Assists licensed professionals in reviewing patient chart notes and payer requirements to determine why cases are an appropriate course of action.
• Assures timeliness and appropriateness of all PA requests and provider appeals according to state, federal, and company guidelines.
• Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual.
• This is an office-based position.

Job description

Amber Specialty Pharmacy in Omaha, NE seeks a Dedicated Authorization Management Specialist in Operations to handle prior authorizations and appeals, communicate with providers and payers, and document activity in EMR systems.

This office-based role requires strong MS Excel/Outlook skills, healthcare industry knowledge, and the ability to meet tight deadlines. Hours are Monday–Friday, 8 a.m.–5 p.m. CST, with no weekend shifts.