Prior Authorization Specialist - Remote

Description

• Experience with Major Medical Insurance
• Knowledge of Pharmacy Benefit
• Knowledge of HCPC Codes (J-Codes)
• Knowledge of ICD-10 Codes (Diagnoses Codes)
• Familiar with medical documentation such as H&P’s, Genetic testing, etc.
• Ability to read prescriptions
• Ability to convert a prescription into an authorization request based on payer requirements
• Ability to interpret medical policies

• Contact plans (PBM or Major Medical) to validate request sent from BV
• Contact physician’s office to obtain current prescriptions
• Contact physician’s office to obtain clinical documentation that is required by the plans
• Validate that the clinical documentation received is what is required by the plan
• Initiate prior authorizations through Cover My Meds
• Follow up on all pending PA’s within 48 hours
• Respond to urgent emails submitted by the Patient Care Coordinator Team or Program Manager in a timely manner
• Obtain approval / denial letters
• Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process
• Initiate re-authorizations that are set to expire 30 days prior to the term date

• BCBSL Medical
• Delta Dental
• EyeMed Vision
• 401k
• Accident & Critical Illness
• Life Insurance
• PTO, Holiday Pay, and Floating Holidays
• Tuition Reimbursement