Prior Authorization Coordinator - West

TrueScripts Management Service; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

TrueScripts Management Service is seeking a detail-oriented Prior Authorization Coordinator for a remote role. You will review and process PA requests for pharmacy claims received electronically, by fax, or from providers or members, verifying documentation and ensuring alignment with benefit plan parameters.

You will work with ePA navigation software, communicate with members, pharmacies and physicians, and move approved requests to the appropriate queues.

Qualifications

• High school diploma required, two-year degree in related field preferred.
• Some experience in pharmacy prior authorizations or retail pharmacy experience.
• Proficiency in Microsoft Office 365 (Word, Excel, Outlook, etc.).
• Effective communication skills with members, physicians’ offices, and pharmacies.

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.

Skills

Customer service

Attention to detail

Problem solving

Analytical thinking

Multitasking

Independence

Effective communication

PBM knowledge

Education

High school diploma

Associate degree (related field)

Tools

Microsoft Office 365

Job description

Remote

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.

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.

To be considered for this role applicants must reside in Pacific time zone

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.

Requirements

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.

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:

To be considered for this role applicants must reside in Pacific time zone

• High school diploma required, or 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.