Pharmacy Prior Authorization Specialist
Job Address:
9299 Market Place
Broadview Heights, OH 44147

Job Description: Prior Authorization Specialist
Reports to: Pharmacy Prior Authorization Manager
Job Type: Full-Time – Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland
Position Overview: The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process.
Key Responsibilities Include but are not limited to:
- Work in cohesion with the Adjudication, Claim Intervention and Billing Departments
- Submit prior authorizations in accordance with Insurance regulations
- Ensure accurate and timely processing of prior authorizations
- Work directly with insurance companies for prior authorization resolution
- Communicate with facilities to gain additional information
- Any other duties assigned
- Follow federal and state regulations
- Adhere to company policies and procedures
- Follow HIPPA guidelines and regulations
Qualifications and Requirements:
- Prior Authorization experience (not required)
- Previous Long-Term Care pharmacy experience a plus (not required)
- Knowledge of Framework LTC a plus (not required)
Salary and Benefits:
- Competitive salary commensurate with experience
- Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more