Specialist I, Prior Authorization

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

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $20.00 - USD $20.00 /Hr.

STAR Bonus % (At Risk Maximum)

0.00 - Ineligible

Work Schedule Description (e.g. M-F 8am to 5pm)

Varies

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Navitus Health Solutions is seeking a Specialist I, Prior Authorization to join our team!

The Specialist I, Prior Authorization (PAS) will review, process, and troubleshoot incoming Prior Authorization requests for various medications. The Specialist I, Prior Authorization (PAS) will accurately process the requests according to regulatory and client specific guidelines. The PAS will work with other team members to meet the departmental performance metrics and maintain compliance. The PAS will work with clinical to ensure requests are processed accurately and timely. The PAS will process requests that come in via phone, fax, and web submission.

Responsibilities

• Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit
• Communicate prior authorization criteria to providers
• Act as a provider help desk specialist to aid providers in submitting prior authorization requests, providing formulary product information, and communicating prior authorization request status
• Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs
• Participate in ad hoc or regularly scheduled Prior Authorization projects or projects for other Navitus departments
• Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
• Utilize work down time for personal and professional development through such activities eLearning classes, participation in the Navitus CPhT program, and by continually reviewing all available resources used in prior authorization processing
• Maintain scheduled hours and demonstrate flexibility to aid in hour coverage
• Other duties as assigned

Qualifications

• A high school degree or equivalent. Post high school education desired such as L.P.N., Certified Pharmacy Technician, Medical Terminology, or Medical Transcriptionist
• Previous customer service experience required
• Previous data entry experience preferred
• Experience in health insurance/pharmacy insurance or managed care organization 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 and/or Medicaid regulatory guidance desired
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

Location

Remote

US