Prior Authorization Specialist I (Healthcare Benefits)

Navitus Health Solutions; United States; Remote; USD 23,000 - 32,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Paid holidays

401K match

Adoption Assistance

Flexible Spending Account

Educational Assistance

Referral Bonus program

Job summary

Navitus Health Solutions is seeking a Specialist I, Prior Authorization to join our team. The Specialist I will review, process, and troubleshoot incoming Prior Authorization requests for various medications in line with regulatory and client guidelines.

The PAS will work with clinical staff to ensure timely, accurate processing, communicate criteria to providers, and assist with formulary information and status updates. We offer a values-driven, inclusive environment with growth opportunities.

Qualifications

• High school degree or equivalent; post-secondary training preferred.
• Experience in health/pharmacy insurance or managed care is a plus.
• Prior authorization processing experience is desirable.

Responsibilities

• Research and analyze electronic and manual claims; troubleshoot issues within policy.
• Communicate prior authorization criteria to providers.
• Assist providers with submitting PA requests and provide formulary information.
• Develop knowledge of Medicare D, Medicaid, and Exchange programs.
• Participate in PA projects and maintain HIPAA compliance.
• Engage in ongoing professional development and adapt to workload changes.
• Adhere to shift hours and support coverage as needed.
• Perform other duties as assigned.

Skills

Customer service

Communication

Data entry

Education

High school diploma or equivalent

Post-secondary training (LPN/Certified Pharmacy Technician)

Job description

Navitus Health Solutions is seeking a Specialist I, Prior Authorization to join our team. The Specialist I will review, process, and troubleshoot incoming Prior Authorization requests for various medications in line with regulatory and client guidelines.

The PAS will work with clinical staff to ensure timely, accurate processing, communicate criteria to providers, and assist with formulary information and status updates. We offer a values-driven, inclusive environment with growth opportunities.