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Job Summary

The Prior Authorization Coordinator coordinates the prior authorization process as well as assists with benefit and claims issues, provides analysis, reporting and documentation regarding pharmacy issues. Incumbent works closely with the internal pharmacy team, vendors, enterprise staff, pharmacies, providers and members to manage pharmacy benefits and assist with prior authorization requests.

Requirements

EDUCATION

Bachelor’s degree in related field. In lieu of degree, five (5) years' pharmacy or healthcare operations experience will be considered.

EXPERIENCE

Minimum three (3) years' pharmacy operations experience, preferably handling prior authorization requests and pharmacy issues.
Knowledge of prior authorization requests, pharmacy operations, pharmacy benefits management, healthcare delivery, healthcare insurance, medical and/or pharmacy claims.

ESSENTIAL SKILLS & ABILITIES

Pharmacy Operations
Prior Authorizations
Analyze Information
Balance Priorities
Microsoft Access
Microsoft PowerPoint
Microsoft Word
Microsoft Excel
Oral & Written Communication
Interpersonal Communication
Professional Judgment
Highly Organized
Ability to work independently or with a team.

Skills

• Active Listening • Analytical Problem Solving • Business Compliance • Collaborative Communications • Critical Thinking • Cross-Functional Communications • Customer Relationship Management (CRM) • Customer Service Workstation • Data Analysis • Data Management • Health Insurance Portability & Accountability Act (HIPAA) • Medical Prescriptions • Microsoft Access • Microsoft Excel • Microsoft PowerPoint • Microsoft Word • Oral Communications • Pharmacy • Problem Sensitivity • Security Awareness • Written Communication

Responsibilities

• Administrators the prior authorization process and provides necessary correspondence, documentation, analysis and reporting to providers, members, pharmacy, or vendors for decision making and resolution of prior authorization requests, inquires and complaints • Assists with testing of new system benefit setup and maintain up-to-date procedural documentation • Performs other duties as assigned • Provides assistance with escalated issues and questions to internal team, external vendors, providers and pharmacies; and analyzes, identifies and researches benefit issues and questions for correction and resolution

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.