Remote Pharmacy Prior Authorization Specialist

TrueScripts Management Service; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

TrueScripts Management Service is seeking a detail-oriented Prior Authorization Coordinator for a remote role. You will review and process PA requests for pharmacy claims received electronically, by fax, or from providers or members, verifying documentation and ensuring alignment with benefit plan parameters.

You will work with ePA navigation software, communicate with members, pharmacies and physicians, and move approved requests to the appropriate queues.

Qualifications

• High school diploma required, two-year degree in related field preferred.
• Some experience in pharmacy prior authorizations or retail pharmacy experience.
• Proficiency in Microsoft Office 365 (Word, Excel, Outlook, etc.).
• Effective communication skills with members, physicians’ offices, and pharmacies.

Responsibilities

• Complete new/renewal prior authorization requests for specialty & non-specialty drugs with accuracy in a timely manner.
• Reach out to members, pharmacies, and physician offices by telephone, email, and fax as deemed necessary.
• Ensure compliance with benefit plan parameters.
• Educate and assist members with pharmacy benefit plan understanding and prior authorization requests.
• Monitor PA queues to ensure PA requests are updated and processed according to company guidelines.
• Investigate, solve problems, and resolve issues related to prior authorization requests.
• Receive automated clinical review responses from ePA and manual clinical reviews from pharmacists.
• Create and send denial letters to providers.
• Move approved prior authorization to the appropriate Member or Clinical Care queues.
• Perform other duties as assigned.

Skills

Customer service

Attention to detail

Problem solving

Analytical thinking

Multitasking

Independence

Effective communication

PBM knowledge

Education

High school diploma

Associate degree (related field)

Tools

Microsoft Office 365

Job description

TrueScripts Management Service is seeking a detail-oriented Prior Authorization Coordinator for a remote role. You will review and process PA requests for pharmacy claims received electronically, by fax, or from providers or members, verifying documentation and ensuring alignment with benefit plan parameters.

You will work with ePA navigation software, communicate with members, pharmacies and physicians, and move approved requests to the appropriate queues.