Prior Authorization Coordinator

ProCare Rx; United States; On-site; USD 50,000 - 75,000; Full time

Job summary

ProCare Rx is seeking a professional to manage authorizations within a fast-paced healthcare environment in the United States. The ideal candidate should have at least 3 years of pharmacy or healthcare experience, proficiency in medical terminology, and strong problem-solving skills. Bilingual candidates in English and Spanish are preferred. The role involves direct communication with insurance companies, provider offices, and patients to secure necessary authorizations and maintain organized documentation.

Qualifications

• Minimum 3 years of pharmacy or healthcare experience required.
• Minimum 1 year management experience of a team of 5 or more employees.
• Ability to manage cases from multiple clientele programs.

Responsibilities

• Process authorizations electronically using various portals and methods.
• Verify coverage and initiate authorizations with insurance companies.
• Maintain clear communication with provider offices and patients.

Skills

Medical terminology knowledge

Bilingual English/Spanish

Customer service skills

Problem solving

Data entry proficiency

Education

High School Graduate

College degree preferred

State Pharmacy Technician registration

Tools

Microsoft applications

Job description

Responsibilities

• Process authorizations electronically, utilizing PA and payer portals, fax or telephone working with payers to secure authorizations.
• Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.
• Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted authorizations.
• Maintain clear communication and documentation with provider offices, patients and pharmacy account managers.
• Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.
• Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
• Verify the accuracy and quality of data entry within authorizations prior to submission.
• Ability to confirm whether a therapy is complete and if an authorization renewal is needed.
• Initiate and follow-up on authorization renewal requests as assigned.
• To safeguard, protect, and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and company policies/procedures.
• Assess, prioritize and resolve client issues using good listening and comprehension skills.
• Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.
• Assist Reimbursement Director in supervising, guiding, and continual training of PA Coordinators.
• Demonstrate working knowledge of all facets of the role, relevant regulations & organizational and departmental policies & procedures.
• Escalate issues to management as appropriate.
• Perform other duties as assigned to support the business.

Qualifications

• Strong understanding of medical terminology, insurance plans and authorization processes.
• Bilingual English/Spanish is a plus.
• Minimum 3 years of pharmacy or healthcare experience required.
• Minimum 1 year management experience of a team of 5 or more employees.
• Working in a fast-paced environment for 3+ years is required.
• Ability to manage cases from multiple clientele programs and follow program business rules.
• Proficiency with data entry functions and Microsoft applications required.
• Ability to work independently and on a team.
• Excellent communication, problem solving and customer service skills.
• Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.
• Ability to use multiple PC monitors and navigate through several software systems effectively.

Education

• High School Graduate required, College degree preferred.
• State Pharmacy Technician registration or PTCB National Certification preferred.

Physical Demands

• Requires sitting, standing, and occasional light lifting.

Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.