Remote Prior Authorization Specialist I

Lumicera; Northern (KY); Hybrid; USD 28,000 - 32,000; Full time

Job summary

Lumicera Health Services, a Navitus-powered specialty pharmacy solutions provider, seeks a Specialist I, Prior Authorization. You will review, process, and troubleshoot incoming Prior Authorization requests via phone, fax, and web, ensuring compliance and timely handling.

You will collaborate with clinical teams to meet performance metrics, maintain privacy per HIPAA, and develop knowledge of Medicare/Medicaid programs.

Qualifications

• High school diploma or equivalent required.
• Post high school education such as LPN, CPhT preferred.
• Experience in health insurance/pharmacy insurance or managed care preferred.
• Prior authorization processing experience desired.
• Experience in PBM or managed care call center desired.
• Experience in mail or retail pharmacy setting desired.
• Experience with Medicare/Medicaid regulatory guidance desired.
• Compliance program participation and cooperative work style expected.

Responsibilities

• Research and analyze electronic and manual claims; troubleshoot issues.
• Communicate prior authorization criteria to providers.
• Assist providers in submitting prior authorization requests with formulary information.
• Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs.
• Participate in Prior Authorization projects or other Navitus department projects.
• Protect patient health information and comply with HIPAA.
• Use downtime for eLearning and professional development; participate in Navitus CPhT program.
• Maintain hours and provide coverage as needed.
• Other duties as assigned.

Skills

Customer service

Data entry

Communication

Problem solving

Education

High school diploma or equivalent

L.P.N. (preferred)

Certified Pharmacy Technician (CPhT)

Medical Terminology

Medical Transcriptionist

Job description

Lumicera Health Services, a Navitus-powered specialty pharmacy solutions provider, seeks a Specialist I, Prior Authorization. You will review, process, and troubleshoot incoming Prior Authorization requests via phone, fax, and web, ensuring compliance and timely handling.

You will collaborate with clinical teams to meet performance metrics, maintain privacy per HIPAA, and develop knowledge of Medicare/Medicaid programs.