Prior Authorization Specialist

PHIL, Inc.; San Francisco (CA); On-site; USD 50,000 - 65,000; Full time

Benefits offered by this job

Ground floor opportunity with a growing startup

Impactful work that enhances wellness

Job summary

A health-tech startup based in San Francisco is seeking a full-time Prior Authorization Specialist to support pharmacy operations. The role involves verifying patient insurance coverage, submitting prior authorizations, and assisting health care providers. The successful candidate should have experience in prior authorizations and exceptional communication skills. This position offers an opportunity to contribute to improving patient access to medications in a growing health-tech environment.

Qualifications

• Experience working in prior authorizations, medical insurance billing, or health insurance.
• Access to reliable, high-speed internet for remote processing.
• Reliable transportation for in-office requirements.

Responsibilities

• Verify patient insurance coverage using resources.
• Submit prior authorizations timely via electronic portal.
• Assist providers with appeals processing.
• Document activities accurately using the operating system.
• Work closely with Customer Support to ensure patient success.

Skills

Team player

Exceptional written and verbal communication skills

Adaptability to new workflows

Problem-solving

Customer service

Job description

PHIL is looking for a full-time Prior Authorization Specialist - with a focus on pharmacy support for Monday through Friday shifts.

About the Company

Founded in 2015, PHIL is a San Francisco-based Series D health-tech startup, pioneering the first Software Therapy Deployment Platform for Specialty Pharmaceuticals that treat complex health conditions. Our mission is to ensure consistent, reliable and affordable access to complex therapeutics for our patient community. Partnering with pharmaceutical manufacturers, PHIL offers digital patient access services to improve health outcomes for patients by delivering affordable and timely access to high-cost Specialty therapeutics. We recently completed our Series D financing led by Warburg Pincus, with $122M in capital raised to date with near-term line of sight to profitability. Headquartered in Scottsdale with operational hubs in Scottsdale AZ and Columbus, OH, the company currently employs over 120 individuals and expects to double its employee base in the coming year. For more information on PHIL, visit https://phil.us/

Position Overview

The most important goal here at PHIL is to improve patients' medication adherence by offering a quick and effortless way for patients to get their medications on time. Prior Authorization Specialists ensure that prescribing offices have all of the information that they need in order to efficiently complete electronic coverage requests in addition to providing phone and email support.

Job Duties

• Verifies patient insurance coverage utilizing phone or online resources
• Submit prior authorizations to insurance plans in a timely manner via electronic portal
• Troubleshoots prior authorization submissions and prescription processing with health care providers utilizing phone or online resources
• Verbally assist providers in navigating appeals processing
• Ensures all pertinent medical documentation is accurate and present prior to authorization submission
• Compiles trends in authorization determinations for client and prescriber education
• Document activities appropriately in process notes using our operating system
• Work closely with our Customer Support team to ensure the success of patients that are recommended to us by their physician's office

Requirements

• Proven team player, but can solve problems independently as well
• Exceptional written and verbal communication skills
• Easily adapt to new system and workflow changes
• Demonstrate experience working in prior authorizations, medical insurance billing, and/or health insurance (required)
• Working knowledge of ICD-10 codes and prescription drug names (preferred, but not required)
• Ability to successfully navigate between multiple systems throughout the course of the workday, this includes but is not limited to operational software and vendor portals
• Demonstrate flexibility to perform duties wherever volume deems it necessary
• Customer service experience (preferred)
• Access to reliable, high-speed internet to meet the needs of remote processing (required)
• Reliable transportation and ability to work in office as required

Benefits

• Ground floor opportunity with one of the fastest-growing startups in health-tech
• Solve a problem that matters: be part of a company that uniquely leverages technology to bring wellness to all of its stakeholders