Prior Authorization Reviewer (Remote)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Prior Authorization Reviewer to join our growing team.

Job Summary:

• The purpose of this position is to review verbal and electronic prior authorization requests based upon pre-established criteria and approves or denies authorization and to enter project-specific data and information into the prior authorization processing system.

Responsibilities:

• May approve, deny, dismiss/early close, or withdraw prior authorizations of medication according to guidelines as defined by the client.
• Answer incoming calls daily and in a timely manner.
• Assist callers with questions regarding approval or denial of medications.
• Research and resolve issues.
• Document the caller's questions, issues, and resolution.
• Enter data information into the prior authorization processing system and correct errors as needed.
• Process Requests for Information (RFIs) for client accounts.
• Perform monitoring tasks of the HID/Client database and notify management of errors and/or problems.
• Maintain compliance with all company policies and procedures.
• Perform related duties as assigned by supervisor.
• Meet and/or exceed production, quality, attendance, and adherence standards.
• Provide/assist in training other employees.
• Subject to fingerprinting and background screenings as required.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

• This is a full-time, non-exempt (hourly) direct hire role with Benefits.
• The required work Hours are Monday through Friday, 10:00 AM to 7:00 PM Central, and you may need to work over 30 to 60 minutes after the regular shift ends.
• The selected candidate must also be willing to work alternating Saturday shifts from 10:00 AM to 4:00 PM Central.
• This is a Remote position within the state of Alabama, where the selected candidate must also reside.
• The selected candidate must have a dedicated, private, and secure workspace at home, free from distractions, to ensure productivity and confidentiality, and with reliable high-speed internet service.

#LI-SD1

Required Qualifications/Experience:

• High school diploma OR GED equivalent (or higher level of education).
• 1+ years of retail pharmacy and/or customer contact work experience.
• Active National Certification of Pharmacy Technicians (e.g., PTCB OR ExCPT).
• Must reside in the state of Alabama.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra Health

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."