Prior Authorization Specialist

Description

WHO WE ARE
Polaris Pharmacy Services is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies nationwide. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members.

JOB SUMMARY:

The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers.  The Prior Authorization Specialist must be responsive and courteous when addressing our customers’ needs.  Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers’ trust and respect.

DUTIES/RESPONSIBILITIES:

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers
• Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
• Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Contact providers and/or facility contacts as necessary to obtain additional information
• Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes
• Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
• Complete, communicate, and submit prior authorizations forms in a timely manner
• Support training needs
• Prepare and maintain reports and records for processing
• Perform other tasks as assigned.
• Follow all applicable government regulations, including HIPAA
• Comply with departmental policies regarding safety, attendance, and dress code
• Overtime, holidays, and weekends may be required and/or expected
• Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
• Other duties as assigned; Job duties may vary depending on business needs

Qualifications

QUALIFICATIONS/COMPETENCIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

REQUIRED SKILLS/ABILITIES:        

• Able to read, write, speak, and understand the English language
• Able to retain a large amount of information and apply that knowledge to related situations 
• Able to work in a fast-paced environment
• Basic computer knowledge skills required
• Basic math and analytical skills
• Experience with alpha-numeric data entry
• Proficient in Microsoft Word, Excel, and Outlook required
• Customer Service
• Results-oriented
• Good organization/Attention to detail
• Reliable
• Problem solver
• Able to work various shifts and days
• Adaptability to an ever-changing environment

EDUCATION and/or EXPERIENCE:

• High School diploma or equivalent required
• Minimum of one (1) or more years working as a pharmacy technician in a retail environment preferred (long-term care pharmacy preferred)
• Framework LTC & General computer knowledge & 10-key Number Entry preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
• May be necessary to work extended hours as needed
• May lift and/or move up to 30 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY

• Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
• Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
• Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.

Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.

BENEFITS for full time Employees

• Medical, Dental, and Vision insurance
• 401 (k) (available for Part Time & Full Time EEs)
• Company Paid Life insurance
• Short-term and Long-term disability insurance
• Tuition reimbursement
• Personal Time Off (PTO)
• Competitive pay with annual performance reviews and merit-based raises
• Career growth potential
• Annual on-site voluntary Flu Vaccines
• Employee referral bonus program