Pharmacy Prior Authorization Coordinator

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

The Pharmacy Prior Authorization Coordinator will facilitate the logging in and out of all prior authorization requests, follow-up on said requests to ensure that all are resolved and completed and that all regulatory requirements are met or exceeded. This will include facilitating the process by completing the clinical assessment/survey into the CareRadius system as well as any of the other tasks associated with the request to ensure that a decision can be rendered. The Coordinator will also make outbound notification calls to members and provider offices. Holidays, weekends and overtime will be a requirement of the position.

• High school diploma or GED required. Associates degree preferred.
• One (1) year of customer service/call center operations experience to include six (6) months of pharmacy experience required OR pharmacy tech certification required.
• General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred.
• Familiarity with HMO concept, PC skills and pharmacy on-line system preferred.
• Proven written and verbal communication skills.
• Excellent organizational and time management skills.
• Excellent ability to absorb new concepts and adapt to a changing environment.
• Exhibit creativity and self-motivation, with ability to effectively solve problems as they arise.
• Math aptitude for purposes of calculating simple drug requirements when given doses and prices calculations.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Prior authorization request coordination

• Verify member eligibility and provider fax numbers/information submitted when necessary and filing said requests into the correct member folder based upon the line of business and/or into the CareRadius Prior Authorization system. This will include facilitating the process by completing the clinical assessment/survey into the CareRadius system as well as any of the other tasks associated with the request to ensure that decision can be rendered.

Outreach to members and providers

• Facilitate notification calls to members and providers within all regulatory time frame requirements.

Correspondence

• Responsible for the printing and mailing of all member and provider correspondence (letters) which also includes the faxing process and requests for additional information.

Reports

• As volume dictates, timely and accurate completion of various reports, reimbursement requests, Magellan emails/reports and cancel forwards as assigned by the Supervisor or Advocate.

Medical exception line

• Answer and provide resolution to provider and internal callers regarding formulary/prior authorization questions for all lines of business. Log all calls into call documentation systems. Research and respond to escalated and complex inquiries regarding Pharmacy questions and/or concerns. Ensure that all callers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries. Provide callbacks when necessary.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $21 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.