BrightSpring Health Services

PRIOR AUTHORIZATION SPECIALIST

Job Locations US-KY-LOUISVILLE
ID
2021-23111
Position Type
Full-Time
Line of Business
Pharmacy Alternatives

Our Company

Pharmacy Alternatives Logo_1250x667

Overview

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today.

Responsibilities

  • The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question

Essential Job Responsibilities:

  • Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts
  • Follows up on all claims requiring prior authorization within four to five business days
  • Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis
  • Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on
  • Assists Billing Department with resolving unbilled claims at each month end close
  • Advocates for clients as needed
  • Support for Pharmacy Operations
  • Adjudicates and resolution of claim rejections as needed
  • Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis
  • Other responsibilities as assigned

Qualifications

  • High School Diploma/General Education Diploma required
  • Kentucky Pharmacy Technician License preferred
  • Excellent customer service and communication skills, both written and verbal
  • Ability to prioritize and meet pre-determined deadlines
  • Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
  • Experience in healthcare billing environment (pharmacy preferred)
  • Familiarization with on-line claims processing and Medicaid and Medicare billing practices
  •  Proficient with Microsoft Word & Excel required

About our Line of Business

Pharmacy Alternatives®, a PharMerica company, is a specialized pharmacy provider focused on serving individuals with cognitive, intellectual and developmental disabilities (I/DD) helping people live their best life.  Pharmacy Alternatives combined with PharMerica offer unmatched long-term pharmacy solutions specializing in serving special-needs populations who live in intermediate care facilities, waiver homes, group homes, assisted living, supported-living or foster care.  PharMerica is one of the nation's largest pharmacy companies.  The combined organization offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about Pharmacy Alternatives, please visit www.palrx.com. Follow us on Facebook and LinkedIn.

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