Prior Authorization & Pharmacy Claims Specialist

BrightSpring Health Services; Louisville (KY); On-site; USD 24,796 - 35,817; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health insurance

Dental insurance

Vision insurance

Life insurance

STD & LTD paid by company

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Non-retail/Closed-door environment

Job summary

PharMerica in Louisville is seeking a Prior Authorization Coordinator to focus on completing approvals for pharmacy claims or coordinating with prescribers to switch therapy when insurance does not cover the treatment.

The role requires strong customer service and communication skills, attention to deadlines, and proficiency with Word/Excel. Day-to-day duties include claims tracking, collaboration with billing, and supporting pharmacy operations.

Qualifications

• High School Diploma or GED required.
• Kentucky Pharmacy Technician License preferred.
• Excellent customer service and communication skills.
• Ability to prioritize and meet deadlines.
• Proficient typing and advanced computer skills.
• Experience in healthcare billing environment (pharmacy preferred).
• Familiarization with on-line claims processing and Medicaid and Medicare billing practices.
• Proficient with Microsoft Word & Excel.

Responsibilities

• Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts.
• Follows up on all claims requiring prior authorization within four to five business days.
• Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis.
• Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on.
• Assists Billing Department with resolving unbilled claims at each month end close.
• Advocates for clients as needed.
• Support for Pharmacy Operations.
• Adjudicates and resolution of claim rejections as needed.
• Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis.
• Other responsibilities as assigned.

Skills

Customer service

Communication skills

Multitasking

Typing proficiency

Education

High School Diploma/GED

Kentucky Pharmacy Technician License

Tools

Microsoft Word

Microsoft Excel

Job description

PharMerica in Louisville is seeking a Prior Authorization Coordinator to focus on completing approvals for pharmacy claims or coordinating with prescribers to switch therapy when insurance does not cover the treatment.

The role requires strong customer service and communication skills, attention to deadlines, and proficiency with Word/Excel. Day-to-day duties include claims tracking, collaboration with billing, and supporting pharmacy operations.