Prior Authorization Coordinator

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Evaluate and manage prior authorization requests for pharmacy claims.

• Deliver assistance to TrueScripts’ members.

• Process prior authorizations received through electronic methods, fax, or requests from providers/members.

• Validate received documentation and gather necessary documents in line with benefit plan requirements and pharmacist recommendations.

• Navigate through submitted prior authorizations from receipt to clinical review determination utilizing PA navigation software.

• Complete both new and renewal prior authorization requests for specialty and non-specialty medications.

• Communicate with members, pharmacies, and physician offices via phone, email, and fax as needed.

• Ensure adherence to benefit plan criteria.

• Educate and support members regarding pharmacy benefit plans and prior authorization requests.

• Monitor PA queues and process requests in accordance with company policies.

• Investigate, troubleshoot, and resolve issues associated with prior authorization requests.

• Receive automated clinical review feedback from ePA and manual reviews from pharmacists.

• Draft and dispatch denial letters to providers.

• Transfer approved prior authorizations to the appropriate Member or Clinical Care queues.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Candidates must live within the Pacific time zone.

• A high school diploma is mandatory.

• An associate degree in a relevant field is preferred.

• Proven track record of reliable employment history.

• Some experience in pharmacy prior authorizations or retail pharmacy is desirable.

• Strong communication skills with members, physicians’ offices, and pharmacies.

• Capability to learn and articulate pharmacy benefit plans to beneficiaries.

• A proactive attitude and the ability to diligently navigate through prior authorization queues.

• Ability to work autonomously.

• Proficiency in Microsoft Office 365, encompassing Word, Excel, and Outlook.

• Capacity to multitask and adjust priorities according to business demands.

• Excellent problem-solving skills, analytical thinking, and meticulous attention to detail.

• Eagerness to understand business processes relevant to the Pharmacy Benefit Management (PBM) sector.

🏝️ Benefits

• Fully remote work arrangement.