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Prior Authorization Specialist - Remote

Remote:

Full Remote

Contract:

Full time

Work from:

California (USA), Illinois (USA), United States

Offer summary

Qualifications:

Experience with Major Medical Insurance, Knowledge of Pharmacy Benefit and HCPC Codes, Familiar with ICD-10 Codes and medical documentation, Ability to read prescriptions and convert them, Strong understanding of prior authorization processes.

Key responsabilities:

Validate patient insurance plans and prescriptions
Contact physicians for clinical documentation and prescriptions
Initiate and follow up on prior authorizations
Respond to urgent emails from the Patient Care Coordinator Team
Submit new Complex authorization approvals through audits

Orsini Specialty Pharmacy Pharmaceuticals SME https://www.orsinispecialtypharmacy.com/

See more Orsini Specialty Pharmacy offers

Job description

Description

About Orsini Specialty Pharmacy

"Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™."

Our Mission

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.

LIVE IT Values

At the heart of our company culture, the Orsini LIVE IT core values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.

Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First

Position Summary
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.

Required Knowledge, Skills & Training

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

Essential Job Duties

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