Prior Authorization & Benefits Specialist

WellStar Health System

United States

On-site

USD 45,000 - 55,000

Full time

7 days ago

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Job summary

Wellstar Health System is seeking an Enhanced Benefits Coordinator to serve as the hub for prior authorizations across our medical center and clinics. You will verify insurance and financial information, obtain precertifications, and provide benefits overviews to patients before treatment, acting as the front-line contact for patients, families, providers, nurses, social workers and pharmacies.

The role emphasizes accuracy in processing authorizations, coordinating with Pharmacy and Medication

Qualifications

High School Diploma or GED required; Bachelor's degree preferred.
Pharmacy Technician certification (PHT) preferred or required upon hire.
Experience with benefits, claims adjudication and prior authorizations.

Responsibilities

Screens and processes prior authorization through medical and pharmacy benefits.
Follow-ups with patients, providers and payers for refills and reauthorizations.
Process infusion/injection appointments using IT platforms.
Coordinate with Medication Assistance Coordinators for specialty meds.
Coordinate shipping of patients’ medications to ensure timely delivery.
Collaborate with Pharmacy Department for quality assurance and customer service.