Specialty Prior Authorization Coordinator

Essential Duties & Responsibilities

• Initiates Prior Authorizations, Pre-Certifications, Pre-Determinations and Advanced Benefit Determination requests for new and existing patients.
• Performs pharmacy test claims and follow-up regarding results.
• Work on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance.
• Work with physician offices to facilitate the process of obtaining prior authorization from third party payers in order to maximize patients' access to treatment.
• Help support the appeal process to overturn insurance denials and/or benefit exclusions when needed.
• Works with Intake, Billing and Collection teams to resolve claims issues.
• Maintains confidentiality of all PHI in compliance with state and federal law.
• Other duties may be assigned.

Education and Experience

• High School Diploma or equivalent
• Preferred: Meet state requirements of national certification (CPhT) or other board approved training program, if required by state.
• Previous Prior Authorization and Claims experience is preferred 

Knowledge, Skills, and Abilities

• Demonstrates a high degree of personal responsibility regarding accuracy and quality of work.
• Demonstrates ability to work effectively and maintain expected productivity.
• Ensures accuracy of information being provided to Management for review.
• Schedules own time based on priorities.
• Demonstrates Excellent customer service and Professionalism
• Ability to multi-task
• Ability to communicate effectively, patiently and courteously.
• Ability to work in a high pace, stress environment.
• Should be independent and self-motivated.
• Maintains a good attendance record.

Work Environment / Physical Demands

This position is in a typical office environment which requires prolonged sitting and standing in front of a computer.  In addition, this position requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients and employees. This position may be required to work long hours.