Prior Authorization Coordinator

National Healthcare Solutions Group LLC; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

VerusRx is a PBM-focused company seeking a Prior Authorization Coordinator to process prior authorizations and provide quality customer service to members, providers, and plans. The role requires data entry accuracy and collaborative work with internal teams to support clinical reviews.

Candidates should have 2+ years in PBM or related settings, strong communication skills, and familiarity with CRM Dynamics for documentation and tracking. This position is full-time and US-based.

Qualifications

• Minimum 2 years’ PBM or related experience required.
• Ability to work cooperatively and master required software applications.
• Experience with prior authorization processing and clinical documentation.

Responsibilities

• Assist with PA issues from members, providers, pharmacies via phone and email.
• Document questions, issues, and resolutions in the CRM.
• Send outbound PA requests to provider offices and obtain required documentation.
• Respond to PA status inquiries from stakeholders.
• Finalize PA orders after clinical review and enter overrides.
• Monitor queues and meet turnaround time targets.

Skills

Prior authorization

Customer service

Data entry

CRM Dynamics

Pharmacy knowledge

Tools

Dynamics CRM

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Regular Full Time Professional US

ABOUT US

We are a small, but rapidly growing PBM. Our culture is important to us, so teamwork and open/honest communication are critical to maintain a balanced work/life schedule. Most importantly, we encourage you to have fun, maintain humor in your workday, and set that example for your team. At VerusRx, we believe deeply in diversity and all of the fascinating characteristics that make us each unique. We are focused on equality, inclusion, and keeping up with a modern and progressive approach.

VerusRxis a certified “Great Place to Work”,united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence.

POSITION SUMMARY

This position is responsible for accurately processing prior authorizations in the prior authorization software, primarily finalizing PA determinations with data entry as needed. This position requires the employee to provide quality customer service to internal and external customers via e-mail or phone correspondence. The successful prior authorization coordinator is a detail-oriented, strong communicator and is an organized problem solver. Able to work independently and collaboratively with internal team members and external plan participants. Must be results-oriented with a positive attitude and able to manage time skillfully.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

• Assist with calls transferred from Member Service Representatives (MSRs) for prior authorization-related issues; research and resolve questions from members, providers, pharmacies, and other callers, including explaining PA denials.
• Document callers’ questions, issues, and resolution in the CRM (Dynamics).
• Send outbound PA request forms via fax to provider offices to initiate prior authorizations and follow up by phone as needed to obtain required clinical documentation.
• Respond to emails to initiate prior authorizations and address PA status inquiries from internal and external stakeholders (e.g., providers, members, internal teams).
• Finalize PA orders following clinical review by a Pharmacist or PA Technician, documenting the decision in the CRM (Dynamics) and entering overrides upon approval.
• Monitor assigned queue(s) and case volume to help meet turnaround time (TAT) targets.

Other job duties include, but are not limited to the following:

• Meet and/or exceed production, quality, attendance, and adherence standards.
• Perform other duties as assigned.
• Minimum of 2 years’ experience in PBM or related (retail or hospital pharmacy)
• Ability to work cooperatively
• Ability to master computer/software applications necessary for completing job tasks as required.
• Ability to understand functionality of applications for processing PA reviews (data entry).

OTHER DETAILS

Supervisory Responsibilities

None.

The noise level in the work environment is usually low to moderate.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand, walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.

The Company complies with employment regulations as they apply to the location of service.