Pharmacy Prior Authorization Senior Representative

As a Pharmacy Prior Authorization Senior Representative, you will be working on a specialized team focused on high touch programs to assist patients. This role is very detail-oriented, and you will spend most of your day researching benefits, obtaining prior authorizations, processing orders, and talking to the internal sales team, patients, and providers.

In this role, you will be part of a specialized team, working with a specific group of clinics, to complete the prior authorization process using both internal and external pharmacy and clinic systems:

• Accurately enter prescriptions into the system, adjudicate claims, and work rejections.
• Accurately use the clinic-specific EMR to gain additional information needed to submit prior authorizations.
• Adhere to principles stipulated by program-specific contractual agreements and company practices.
• Rapidly and thoroughly investigate processing/benefit inquiries from the Fertility Inside Sales team.
• Conduct insurance inquiries and benefit checks.
• Submit prior authorizations, follow up, and appeals as needed.
• Juggle multiple tasks without sacrificing attention to detail.
• Help patients and providers understand their pharmacy benefits better and answer questions effectively.
• Use strong communication skills to handle internal and external inquiries regarding prior authorizations.
• Participate in program-specific customer meetings and training sessions.
• Participate in special projects and perform other duties as they pertain to specific contract performance.

Requirements:

• High School Diploma or GED required.
• 2+ years of Pharmacy Technician experience.
• Valid National Pharmacy Technician certification is required.
• Valid Arizona, Massachusetts, or Illinois State pharmacy technician license is required.
• Microsoft Office proficiency and data entry skills.
• Strong math skills related to prescription calculations.
• Exceptional attention to detail, accuracy, and quality.
• Excellent verbal and written communication skills.
• Ability to multitask in both PC/Phone-related tasks.
• 1+ year of relevant experience with prior authorization submission using CoverMyMeds or other like electronic prior authorization tools.
• Experience with prior authorization appeals and denials.
• Experience working with clinical EMR systems and/or Infertility is a plus, but not required.
• Works effectively and fosters teamwork; demonstrates ownership of projects and carries responsibility for building strong working relationships with colleagues and customers.
• Results-oriented; demonstrated ability to prioritize and manage workload and meet deadlines.

Schedule:

• Ability to work a scheduled 8-hour shift, from 12:30 PM - 9:00 PM EST, Monday-Friday.
• Weekends as needed.

Salary and Benefits:

• Anticipated hourly rate of 19 - 29 USD/hour, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs.
• 401(k), company-paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.