Senior Pharmacy Prior Authorization Representative

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Accurately input prescriptions into the system, adjudicate claims, and address rejections.

• Utilize clinic-specific EMR systems to collect information for prior authorizations.

• Comply with program-specific contractual agreements and company policies.

• Investigate processing and benefits inquiries from the Fertility Inside Sales team.

• Conduct insurance inquiries and perform benefit checks.

• Submit, track, and appeal prior authorizations as necessary.

• Assist patients and providers in understanding pharmacy benefits and answer inquiries.

• Manage both internal and external prior authorization inquiries.

• Take part in program-specific customer meetings and training sessions.

• Engage in special projects and undertake additional duties associated with contract performance.

• Collaborate with a specialized team supporting certain groups of clinics and high-touch patient programs.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• A minimum of 2 years of experience as a Pharmacy Technician is required.

• A valid National Pharmacy Technician certification is required.

• A valid pharmacy technician license from Arizona, Massachusetts, or Illinois is required.

• Proficiency in Microsoft Office and data entry skills are necessary.

• Strong mathematical skills related to prescription calculations are essential.

• Exceptional attention to detail, accuracy, and quality is required.

• Excellent verbal and written communication skills are necessary.

• Ability to multitask effectively in both PC and phone-related tasks.

• At least 1 year of relevant experience with prior authorization submissions using CoverMyMeds or similar electronic tools is required.

• Experience with prior authorization appeals and denials is essential.

• Familiarity with clinical EMR systems and/or infertility is a plus, but not mandatory.

• Capability to prioritize and manage workload while meeting deadlines is necessary.

• If working remotely, a cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload is required.

• Availability to work specified weekday shifts and weekends as needed.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits commence on the first day of employment.

• Access to well-being and behavioral health programs.

• Participation in a 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence available.