Prior Authorization Specialist

PharMerica; Louisville (KY); Hybrid; USD 40,000 - 56,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Health insurance

401k

Paid-time off

Tuition reimbursement

Job summary

Join PharMerica as a Prior Authorization Coordinator in Louisville, KY, where you will focus on completing pharmacy claims requiring prior authorization for long-term care clients. This role involves collaborating with prescribers and handling claims efficiently.

The position requires excellent communication and multi-tasking skills, ideally with prior experience in the healthcare billing environment. PharMerica offers competitive pay, flexible schedules, and various benefits including insurance

Qualifications

• Experience in healthcare billing environment, preferably pharmacy.
• Familiarity with on-line claims processing and Medicaid/Medicare billing practices.
• Strong technical skills and proficiency in typing.

Responsibilities

• Complete prior authorization paperwork for pharmacy claims.
• Follow up on claims requiring prior authorization within 4-5 business days.
• Track claims in QuickBase and provide weekly updates to the Director of Pharmacy.

Skills

Customer service

Communication skills

Multi-tasking

Microsoft Word

Microsoft Excel

Education

High School Diploma

Kentucky Pharmacy Technician License

Tools

QuickBase

Docutrack

CoverMyMeds

Job description

Overview

Our Company

Pharmacy Alternatives

Join our PharMerica team!

PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!

The ideal candidate has experience in healthcare billing environment (pharmacy preferred) and is familiar with on-line claims processing and Medicaid and Medicare billing practices

Schedule

Mon-Fri(8:30am to 5pm)

This is not a remote opportunity. Applicants must reside in, or commutable distance, to Louisville, KY. A Hybrid schedule will be available after training: office on Wednesdays and home off on other days

We Offer

• DailyPay
• Flexible schedules
• Competitive pay
• Shift differential
• Health, dental, vision and life insurance benefits
• Company paid STD and LTD
• Tuition Assistance
• Employee Discount Program
• 401k
• Paid-time off
• Tuition reimbursement

• Position will be posted for a minimum of 7 business days

Responsibilities

• The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question

Essential Job 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

Qualifications

• High School Diploma/General Education Diploma required
• Kentucky Pharmacy Technician License preferred
• Excellent customer service and communication skills, both written and verbal
• Ability to prioritize and meet pre-determined deadlines
• Must be able to effectively multi-task, be proficient at typing, and have advanced technical 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 required

About Our Line Of Business

Pharmacy Alternatives®, an affiliate of PharMerica, is a specialized pharmacy provider focused on serving individuals with cognitive or intellectual and developmental disabilities (I/DD). Pharmacy Alternatives offers long-term pharmacy solutions specializing in serving special-needs populations who live in intermediate care facilities, waiver homes, group homes, assisted living, supported-living or foster care. Our state-of-the-art approach includes packaging technology specially designed for the population we serve and electronic medication management that helps people live their best lives. For more information, please visit www.pharmacyalternatives.com . Follow us on Facebook and LinkedIn .