Prior Authorization Specialist

BrightSpring Health Services; Louisville (KY); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health, dental, vision and life ins.

Company paid STD and LTD

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Job summary

PharMerica in Louisville, KY is seeking a Prior Authorization Coordinator to ensure timely authorizations for pharmacy claims and to coordinate therapy changes when insurance does not cover treatments.

The role supports the Billing and Pharmacy Operations teams in a non-retail, closed-door setting.

Qualifications

• Requires a High School Diploma or GED.
• Pharmacy Technician License in KY preferred.
• Experience in healthcare billing environment (pharmacy preferred).
• Familiar with on-line claims processing and Medicaid/Medicare billing practices.
• Proficient with MS Word & Excel.

Responsibilities

• Complete prior authorization and change-of-therapy paperwork with prescribers and facility contacts.
• Follow up on claims requiring prior authorization within 4–5 business days.
• Maintain and review QuickBase tracking; share reports weekly.
• Cross-check unbilled claims with QuickBase to ensure follow-up.
• Assist Billing with resolving unbilled claims at month-end close.
• Advocate for clients when needed; support Pharmacy Operations.
• Resolve claim rejections; utilize frameworks and Docutrack.
• Daily use of QuickBase, Docutrack, and CoverMyMeds in workflow.

Skills

Customer service

Communication

Prioritization

Multi-tasking

Typing

Technical skills

Healthcare billing

Online claims processing

Medicaid/Medicare billing

Word & Excel

Education

High School Diploma

Kentucky Pharmacy Technician License

Tools

QuickBase

Docutrack

CoverMyMeds

Frameworks

Microsoft Word

Excel

Job description

Job Locations

US-KY-LOUISVILLE

Overview

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

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centres nationwide.

*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 pharmacysolutions 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.