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

No weekends

Day shift 8 a.m.–5 p.m.

Job summary

Amber Specialty Pharmacy, located in Omaha, NE, seeks an Authorization Management Specialist to prepare appeal summaries and prior authorizations, and communicate with prescribers to document in the EMR. You will gather patient history, evaluate information, and complete PA requests accurately and timely.

The role supports providers, health plans, PBMs, and patients, ensuring timely PA submissions while maintaining full compliance with regulations and company policies.

Qualifications

• Working knowledge of the healthcare industry.
• HIPAA trained and/or the ability to protect highly confidential patient and employee information.
• Six months or less of similar or related work experience.

Responsibilities

• Initiates and completes prior authorizations and appeals for specialty pharmacy.
• 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, and patients to obtain the 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.
• Evaluate and process claims rejected for prior authorization following company policies and procedures.
• 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.

Skills

Strong communication

Detail oriented

Time management

Problem solving

Education

High school diploma or equivalent

Tools

MS Excel

MS Word

MS Outlook

Skype

Job description

Amber Specialty Pharmacy, located in Omaha, NE, seeks an Authorization Management Specialist to prepare appeal summaries and prior authorizations, and communicate with prescribers to document in the EMR. You will gather patient history, evaluate information, and complete PA requests accurately and timely.

The role supports providers, health plans, PBMs, and patients, ensuring timely PA submissions while maintaining full compliance with regulations and company policies.