Senior Pharmacy Prior Authorization Representative

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

📋 Description

• Conduct research on benefits and secure prior authorizations

• Process prescription orders and liaise with sales teams, patients, and healthcare providers

• Input prescriptions, adjudicate claims, and address claim rejections

• Utilize clinic-specific EMR systems to gather information for prior authorization submissions

• Adhere to program-specific contractual agreements and company policies

• Address processing and benefit inquiries from the Fertility Inside Sales team

• Execute insurance inquiries and benefit verifications

• Submit, monitor, and appeal prior authorizations as necessary

• Clarify pharmacy benefits and respond to inquiries from patients and providers

• Manage internal and external prior authorization requests

• Attend program-specific customer meetings and training sessions

• Engage in special projects and perform tasks related to contract performance

⛳️ Requirements

• High School Diploma or GED is mandatory

• A minimum of 2 years of experience as a Pharmacy Technician

• Valid National Pharmacy Technician certification is required

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

• Proficiency in Microsoft Office and data entry skills

• Strong mathematical abilities pertaining to prescription calculations

• Exceptional attention to detail, accuracy, and quality

• Outstanding verbal and written communication skills

• Capability to multitask across both PC and phone-related tasks

• At least 1 year of relevant experience with prior authorization submissions using CoverMyMeds or comparable electronic tools

• Familiarity with prior authorization appeals and denials

• Experience with clinical EMR systems and/or infertility is advantageous, but not mandatory

• Availability to work during specified training and scheduled shifts, including weekends as required

• For remote work, a cable broadband or fiber optic internet connection with a minimum of 10 Mbps download and 5 Mbps upload speed is necessary

• Ability to prioritize tasks, manage workload effectively, meet deadlines, and foster strong working relationships

🏝️ Benefits

• Eligibility for an annual bonus plan

• Medical, vision, and dental benefits commencing on the first day

• Access to well-being and behavioral health programs

• 401(k) plan

• Company-sponsored life insurance

• Tuition reimbursement opportunities

• A minimum of 18 days of paid time off annually

• Paid holidays

• Leave of absence options