Prior Authorization
Join to apply for the Prior Authorization role at reputed company Continue with reputed company Continue with reputed company 4 days ago Be among the first 25 applicants Join to apply for the Prior Authorization role at reputed company Get AI-powered advice on this job and more exclusive features. Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Continue with reputed company Who We Are reputed company is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members. Currently we are recruiting for experienced Prior Authorization Technicians to join the reputed company team. PRIOR AUTHORIZATION SPECIALIST Who We Are reputed company is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members. Currently we are recruiting for experienced Prior Authorization Technicians to join the reputed company team. Overview The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to reputed company and their customers. The Prior Authorization Specialist must be responsive and courteous when addressing our customers needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect. Responsibilities Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to reputed company and their customers Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement Contact providers and/or customers as necessary to obtain additional information Monitor and resolve revenue at risk reputed company with payer set up, billing, rebilling, and reversal processes Work as a team to identify, document, communicate, and resolve payer/billing trends and issues Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner Review and work convert billing exception reports to ensure claims are billed to accurate financial plans Complete billing transactions for non-standard order entry situations as required Support training needs Prepare and maintain reports and records for processing Perform other tasks as assigned. Follow all applicable government regulations, including HIPAA Comply with departmental policies regarding safety, attendance, and dress code Overtime, holidays, and weekends may be required and/or expected reputed company job responsibilities in accordance with the standards set out in the Companys Code of Business reputed company and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards Other duties as assigned; Job duties may vary depending on business needs Qualifications High School diploma or equivalent required Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred) Framework LTC & General computer knowledge & 10-key Number Entry preferred Able to read, write, speak, and understand the English language Able to retain a large amount of information and apply that knowledge to related situations Able to work in a fast-paced environment Basic computer knowledge skills required Basic math and analytical skills Experience with reputed company data entry Proficient in reputed company Word, Excel, and Outlook required Customer Service Results-oriented Good organization/Attention to detail Reliable Problem solver Able to work various shifts and days Adaptability to an ever-changing environment PHYSICAL DEMANDS The Physical Demands Described Here Are Repres
