Job Description
Prior Authorization Specialist–REMOTE
Equity Staffing is searching for several Remote Prior Authorization Specialists in the United States. This position is with a Fortune 500 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!
*** Position is 100% Remote, Anywhere in the United States except from California ***
*** 7 Month Temporary Position ***
Specific Duties:
- Sort electronic copies of incoming fax transmittals, and index them into the appropriate Prior Authorization System (PAS) workbaskets
- Research and identifying member, provider, and drug information across multiple computer systems
- Review Incoming PA faxes and initiate coverage determination requests in a timely manner within SLA
- Navigate across multiple computer systems to identify information needed for outbound calls to members/providers.
- Make outgoing calls as needed to provide information on prior authorization case outcome, follow-up or consultation such as prior authorization requirements, appeals, etc.
- Educate members / guardians, providers, pharmacy staff on procedures to avoid compliance risk.
- Meet departmental established performance expectations and work independently to complete tasks in a timely manner.
- May include processing member prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary.
- May take incoming calls from members or providers and apply benefit plan criteria in making decisions (approvals / denials) or recommendations; clarify and explain pharmaceutical benefits and procedures.
- May partner with others to gather additional information and / or to interpret clinical guidelines; act as a resource for others
- Incumbents typically are not licensed pharmacy technicians.
Must have qualifications/experience:
- High school graduate or GED equivalent
- Prior Authorization/Insurance Verification Experience
- Data Extraction Experience
- Data Entry Experience
- Medical Terminology Knowledge
- Experience working in a fast paced team environment
- Great Multitasker
- Positive Attitude
- Good Typing Skills
- Great Customer Service Skills
- Attention to Detail
- Strong Organizational Skills
- Effective communication skills both written and verbal
- Strong computer skills
- Proficient in Microsoft Office Suite of Tools.
- Critical thinking skills.
- Ability to work with others