Prior Authorization Coordinator - Part Time - West

TrueScripts Management Services, LLC; Henderson, Northern (NV, KY); Hybrid; USD 25,000 - 39,000; Part time

Job summary

TrueScripts Management Services, LLC is seeking a part-time Prior Authorization Coordinator to review and process PA requests for pharmacy claims, including ePA, fax, and provider/member submissions. The role requires ensuring documentation meets benefit plan parameters and expert navigation of PA systems to drive timely determinations.

Applicants must reside in the Pacific Time Zone. The position is up to 24 hours per week and may involve outreach to members, pharmacies, and physician offices

Qualifications

• High school diploma required, two-year degree in related field preferred.
• Some experience in pharmacy prior authorizations or retail pharmacy.
• Effective communication with members, physicians’ offices, and pharmacies.
• Ability to learn and explain pharmacy benefit plans to benefit holders.
• Proactive mindset, with ability to work diligently through prior authorizations queues.
• Ability to work independently.
• Proficiency in Microsoft Office 365 (Word, Excel, Outlook, etc.).
• Capacity to multitask and adjust priorities based on business needs.
• Collaborative team player mindset with strong problem-solving abilities, analytical thinking, and attention to detail.
• The drive to learn business processes specific to the Pharmacy Benefit Management (PBM) industry.

Responsibilities

• Process new and renewal PA requests for specialty & non-specialty drugs with accuracy in a timely manner.
• Reach out to members, pharmacies, and physician offices by telephone, email, and fax as deemed necessary.
• Ensure compliance with benefit plan parameters.
• Educate and assist members with pharmacy benefit plan understanding and prior authorization requests.
• Monitor PA queues to ensure PA requests are updated and processed according to company guidelines.
• Investigate, solve problems, and resolve issues related to prior authorization requests.
• Receive automated clinical review responses from ePA and manual clinical reviews from pharmacists.
• Create and send denial letters to providers.
• Move approved prior authorization to the appropriate Member or Clinical Care queues.
• Perform other duties as assigned.

Skills

Communication

Multitasking

Independent work

Problem solving

Attention to detail

Analytical thinking

Team player

Education

High school diploma

Two-year degree preferred

Tools

Microsoft Office 365

PA navigation software

Job description

Description

Position Overview:

This is a general role that handles the review and processing of prior authorization requests for pharmacy claims while providing exceptional service to TrueScripts’ members. The Prior Authorization Coordinator is responsible for prior authorizations received electronically (ePA), via fax, or by provider or member request. The Prior Authorization Coordinator will verify what documentation has been received and obtain any necessary documentation required by benefit plan parameters per guidance of pharmacist. The Prior Authorization Coordinator will be an expert in the use of PA navigation software and will be responsible for the navigation of all submitted PAs from receipt through clinical review determination. **To be considered for this role applicants must reside in Pacific time zone** This is a part time position working up to 24 hours a week.

Principal Roles and Responsibilities:

• Complete new/renewal prior authorization requests for specialty & non-specialty drugs with accuracy in a timely manner.
• Reach out to members, pharmacies, and physician offices by telephone, email, and fax as deemed necessary.
• Ensure compliance with benefit plan parameters.
• Educate and assist members with pharmacy benefit plan understanding and prior authorization requests.
• Monitor PA queues to ensure PA requests are updated and processed according to company guidelines.
• Investigate, solve problems, and resolve issues related to prior authorization requests.
• Receive automated clinical review responses from ePA and manual clinical reviews from pharmacists.
• Create and send denial letters to providers.
• Move approved prior authorization to the appropriate Member or Clinical Care queues.
• Perform other duties as assigned.

Qualifications:

• High school diploma required, two-year degree in related field preferred.
• Demonstrated reliable work history.
• Some experience in pharmacy prior authorizations or retail pharmacy experience.
• Effective communication skills with members, physicians’ offices, and pharmacies.
• Ability to learn and explain pharmacy benefit plans to benefit holders.
• Proactive mindset, with ability to work diligently through prior authorizations queues.
• Ability to work independently.
• Proficiency in Microsoft Office 365 (Word, Excel, Outlook, etc.).
• Capacity to multitask and adjust priorities based on business needs.
• Collaborative team player mindset with strong problem-solving abilities, analytical thinking, and attention to detail.
• The drive to learn business processes specific to the Pharmacy Benefit Management (PBM) industry.