Authorization Specialist

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

Responsible for obtaining initial prior authorization and renewal authorizations. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations. 

Responsibilities

• Obtain initial and renewal authorizations for enteral, infusion, and/or specialty therapies from insurance companies.

• Ensures initial and renewal authorizations are followed up on in a timely manner.

• Interface with other departments and identify medical documentation in support of prior authorization requests.

• Takes the initiative to present ideas/suggestions to management.

• Utilizes appropriate communication lines in relaying problems, concerns, questions, and ideas.

• Demonstrates the ability to work effectively and maintain expected productivity.

• Cooperates with other staff members when planning and organizing daily activities.

• Always maintains courteous demeanor.

• Prioritizes and completes work on schedule.

• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks.

• Demonstrates ability to communicate effectively and express ideas clearly.

• Performs in accordance with system-wide competencies/behaviors.

• Performs other duties as assigned.

Skills & Abilities

• Team player.

• Gives high priority to client satisfaction and customer needs.

• Maintains confidentiality of patient information.

• Provides customer service to all internal and external customers. 

• Good verbal and written communication skills.

• Computer literate, with the ability to utilize standard software applications including Windows and MS Office Suite (Outlook, Word, and Excel).

• Good organizational skills with attention to detail and ability to multitask.

Requirements

• HS diploma or GED required.

• 1+ years of pharmacy claims, pharmacy tech, and/or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.

• Knowledge of medical terminology, coordination of benefits.

• Knowledge of payer websites preferred.

• Knowledge of medical terminology required.

• Knowledge of pharmacy payers and authorization requirements preferred.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.