Prior Authorization Specialist I (Remote Eligible)

MedImpact Healthcare Systems Inc.; Tempe (AZ); On-site; USD 24,000 - 38,000; Full time

Benefits offered by this job

Medical benefits

Paid time off

401K with company match

Life and disability insurance

Tuition reimbursement

Employee referral bonus

Job summary

MedImpact Healthcare Systems, Inc. in Tempe, AZ is seeking an experienced Prior Authorization Specialist to join the Operations team.

You will process PA requests, use clinical guidelines, and communicate with physicians and pharmacies to obtain or verify information, aiming for timely, accurate determinations according to client requirements. This role requires a GED/HS diploma and at least 1 year of relevant experience; proficiency with MS Office; and the ability to handle high-volume

Qualifications

• GED/HS Diploma and 1+ year experience or equivalent combination of education and experience
• Experience with prior authorization workflows and clinical guidelines
• Strong attention to detail and communication skills

Responsibilities

• Process and finalize Prior Authorization (PA) requests within clients’ turnaround time and Performance Guarantees utilizing guidelines.
• Enter PAs into the system and prioritize requests.
• Check formulary alternatives, review tried and failed medications.
• Utilize drug references and verify the drug being requested is indicated and approved for the condition.
• Document all related information regarding the PA approval or non-approval.
• Respond to requests by faxing status of the PA to the physician or pharmacy
• Conforms to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision making.

Skills

Prior Authorization

PA Processing

Customer Service

MS Office

Education

GED/HS Diploma

1+ year experience

Tools

MS Office

Excel

Outlook

Job description

MedImpact Healthcare Systems, Inc. in Tempe, AZ is seeking an experienced Prior Authorization Specialist to join the Operations team.

You will process PA requests, use clinical guidelines, and communicate with physicians and pharmacies to obtain or verify information, aiming for timely, accurate determinations according to client requirements. This role requires a GED/HS diploma and at least 1 year of relevant experience; proficiency with MS Office; and the ability to handle high-volume