Prior Authorization Specialist

Pharmacy Alternatives; Louisville (KY); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health, dental, vision and life保险

Company paid STD and LTD

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Job summary

Pharmacy Alternatives, an affiliate of PharMerica, is seeking a detail-oriented Prior Authorization Coordinator for a non-retail, closed-door pharmacy serving long-term care and senior living clients in Louisville, KY. The role focuses on timely PA processing, claims tracking, and collaboration with prescribers and facilities.

The ideal candidate has healthcare billing experience, familiarity with online claims, and strong Excel/Word skills.

Qualifications

• High School Diploma or GED is required.
• Pharmacy Technician license (Kentucky) preferred.
• Excellent customer service and communication skills, written and verbal.
• Ability to prioritize and meet deadlines.
• Proficient with Microsoft Word and Excel.
• Experience in healthcare billing and online claims processing (Medicaid/Medicare) preferred.

Responsibilities

• Complete client prior authorization and therapy change paperwork with prescribers and facility contacts.
• Follow up on all claims requiring prior authorization within 4–5 business days.
• Track claims in QuickBase and report to Director of Pharmacy weekly.
• Review unbilled claims requiring prior authorization and ensure follow-up.
• Assist Billing Department with unbilled claims at month-end close.
• Adjudicate claim rejections and support Pharmacy Operations.

Skills

Customer service

Communication

Prioritization

Typing

Technical skills

Education

High School Diploma/General Education Diploma

Kentucky Pharmacy Technician License preferred

Tools

Microsoft Word

Excel

QuickBase

Docutrack

CoverMyMeds

Frameworks

Job description

Overview

Our Company

Pharmacy Alternatives

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

• 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 .