Prior Authorization Specialist

Asembia; Livingston (NJ); On-site; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a Prior Authorization Specialist to join their dynamic team. In this role, you'll assist with prior authorizations, appeals, and verifications, ensuring seamless communication between patients, providers, and insurance companies. The position requires strong organizational skills and a solid understanding of pharmacy laws and insurance systems. This opportunity offers a chance to make a meaningful impact in the specialty pharmaceutical service model, where your contributions will help improve patient outcomes. If you are passionate about healthcare and thrive in a fast-paced environment, we want to hear from you!

Qualifications

• At least 2 years of pharmacy experience preferred.
• Knowledge of pharmacy laws and insurance systems required.

Responsibilities

• Assisting with prior authorizations and appeals.
• Updating patient insurance information and authorizations.
• Communicating with care teams and insurance companies.

Skills

Insurance Verification

Prior Authorization

Communication Skills

Data Entry

Pharmacy Knowledge

Education

Certified Pharmacy Technician

Pharmacy Technician License

Tools

MS Office

Electronic Systems for Referrals

Job description

Join to apply for the Prior Authorization Specialist role at Asembia.

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Responsibilities include:

1. Assisting with prior authorizations, appeals, and denials.
2. Updating and verifying current patient insurance information.
3. Updating authorizations and claims to reflect insurance changes.
4. Sorting daily work queues and reports for processing.
5. Maintaining knowledge of insurance benefit terms and processes.
6. Communicating effectively with the care team, physicians, staff, and payers.
7. Preparing supporting documentation for authorizations and appeals.
8. Investigating denials and appeals.
9. Reviewing clinical notes and submitting prior authorizations via ePA or other methods.
10. Obtaining and reviewing documentation from physicians for appeals.
11. Following up with physicians and insurance companies on authorization statuses.

Primary functions and responsibilities include:

1. Monitoring schedules for authorization requirements.
2. Verifying insurance eligibility and benefits.
3. Completing referrals and authorizations timely.
4. Communicating with patients and providers to resolve issues.
5. Using electronic systems to manage referrals and authorizations.
6. Requesting and preparing documentation to support medical necessity.
7. Providing feedback on workflow issues.
8. Ensuring accurate data entry and confidentiality.

Work hours involve rotating shifts between 8:30 AM to 8:00 PM EST, including overtime and occasional weekends.

Job scope includes:

1. Identifying procedures requiring authorization.
2. Understanding insurance guidelines and clinical policies.
3. Verifying insurance coverage.
4. Completing authorizations promptly.
5. Effective communication to prevent denials.
6. Using system tools effectively.
7. Supporting documentation for medical necessity.
8. Providing feedback to supervisors.
9. Maintaining patient confidentiality and professionalism.

Qualifications vary by location:

• New Jersey: Certified Pharmacy Technician registered with the NJ Board of Pharmacy.
• Arizona: Pharmacy Technician License with national certification or Technician Trainee License.
• All locations: At least 2 years pharmacy experience preferred, knowledge of pharmacy laws, insurance systems, and proficiency in MS Office.

If you are a good fit, apply now. We look forward to discussing your potential role with Asembia.

About Asembia: For over a decade, we have partnered with industry stakeholders to develop solutions in the high-touch specialty pharmaceutical service model, focusing on comprehensive services and innovative technology to improve patient outcomes.

Asembia is an Equal Opportunity Employer, committed to diversity and compliance with applicable laws.