Senior Pharmacy Prior Authorization Representative

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

📋 Description

• Secure initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance providers using portal, phone, and fax.

• Follow up on the status of initial and renewal authorizations in a timely manner.

• Work collaboratively with clinicians and other departments to gather necessary medical documentation.

• Inform patients, prescribers, and internal teams about insurance denials and the appeals process.

• Verify plan eligibility and manage the processing of test claims.

• Calculate the required units and quantities in relation to day supply.

• Prioritize and complete assigned tasks within the designated timeframes.

• Respond promptly to chat and email update requests.

• Address problems, concerns, questions, and ideas through the appropriate channels.

• Maintain productivity and quality standards as expected.

• Execute other assigned tasks as needed.

⛳️ Requirements

• High School diploma or GED is required.

• A minimum of 2+ years of experience in prior authorization, insurance verification, or related roles in a physician practice, ancillary provider, or relevant healthcare environment is required.

• Proficiency in medical terminology is necessary.

• Familiarity with payer websites, eligibility, and coordination of benefits is essential.

• Understanding of plan formularies and authorization requirements is required.

• Knowledge of pharmacy versus medical payers and their authorization processes is necessary.

• Strong computer skills and proficiency in Microsoft Office products are required.

• Computer literacy, including knowledge of Windows and the MS Office Suite (Outlook, Word, and Excel) is necessary.

• Excellent organizational skills with keen attention to detail and the ability to multitask are essential.

• Strong verbal and written communication skills are needed.

• Ability to uphold confidentiality regarding patient information is mandatory.

• Must have a reliable internet connection through cable broadband or fiber optic service with a minimum of 10Mbps download and 5Mbps upload speed when working remotely.

🏝️ Benefits

• Option for remote work (either occasionally or permanently).

• Requirement for cable broadband or fiber optic internet for home-based work, with at least 10Mbps download and 5Mbps upload speed.

• Tobacco-free workplace policy.

• Support for reasonable accommodations during the online application process.