Remote Prior Authorization Specialist I

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

Benefits offered by this job

Health insurance

PTO 20 days

Parental leave

9 paid holidays

401K match

Adoption Assistance

FSAs

Education assistance

Referral bonus

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, applying regulatory and client guidelines to ensure timely, accurate decisions.

The role involves collaborating with clinicians, providers, and internal teams to support efficient processing. Qualifications include a high school diploma with preference for postsecondary health-care

Qualifications

• High school diploma or equivalent; postsecondary health education is a plus.
• Previous customer service experience required.
• Previous data entry experience preferred.
• Experience in health insurance/pharmacy insurance or managed care is preferred.
• Prior authorization processing experience desired.
• Experience in a PBM or managed care call center desired.
• Experience in a mail or retail pharmacy setting desired.
• Experience with Medicare/Medicaid regulatory guidance desired.
• Ability to interact cooperatively and respectfully with others.

Responsibilities

• Research and analyze electronic and manual claims; troubleshoot issues.
• Communicate prior authorization criteria to providers.
• Assist providers as a help desk specialist for prior authorization submissions.
• Develop and maintain knowledge of Medicare, Medicaid, and/or Exchange programs.
• Participate in Prior Authorization projects or cross-department projects.
• Protect patient information and comply with HIPAA regulations.
• Engage in eLearning and Navitus CPhT program for ongoing development.
• Maintain scheduled hours with flexibility for coverage.
• Other duties as assigned.

Skills

Customer service

Data entry

Teamwork

Education

High school diploma

Post-secondary education desired

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, applying regulatory and client guidelines to ensure timely, accurate decisions.

The role involves collaborating with clinicians, providers, and internal teams to support efficient processing. Qualifications include a high school diploma with preference for postsecondary health-care