Authorization Management Specialist

We are seeking a Authorization Management Specialist to join our Omaha team! Do you have experience with prior authorizations, prescription adjudication or knowledge about medical insurance? If so, check out the job below!

Responsible for preparing appeal summaries and prior authorizations, correspondence with prescriber's offices and documenting information in the electronic medical record. Gathers pertinent patient history and information, evaluates responds and completes appeals and prior authorizations in an accurate and timely manner.

Primary Responsibilities:

• Initiates and completes prior authorizations and appeals for specialty pharmacy
• Work directly with providers, health plans, PBM's, and other specialty pharmacies to relay vital information and provide a high level of service
• Communicates with providers, health plans, PBM's, and patients to obtain status of pending prior authorizations and appeals.
• Submits prior authorization and/or appeal requests via electronic, phone or fax on behalf of physicians/providers as allowed.
• Assures that all prior authorization and appeal documents, databases and records are maintained accurately and in a timely fashion.
• Evaluate and process claims rejecting for prior authorization in accordance with company policies and procedures
• Advocates on the patient's behalf to identify and assess coverage issues.
• Assists licensed professional in the review of patient chart notes and payer requirements to determine why cases an appropriate course of action.
• Assures timeliness and appropriateness of all PA requests and provider appeals according to state and federal and company guidelines.

Professional Competencies:

• Understanding of insurance verification and online prescription adjudication
• Working knowledge of Medicare, Medicaid, and Commercial Insurance and renal programs related to pharmacy, billing, grants, copay cards, prior authorizations, and rejections.
• Prior PAP, PA and co-pay card experience preferred
• Prior experience trouble shooting rejected pharmacy claims preferred
• Proficiently read and understand abstract information from handwritten patient medical records.

Educational Requirements:

• High school diploma or equivalent

Licensure and Certification Requirement:

• Nationally Certified Pharmacy Technician preferred

Our benefits include:

• Hy-Vee Perks Membership, + Benefits (Medical, Dental, Vision, Flexible Spending, Life insurance, Retirement planning etc.), Flexible Working Options.
• This position is Monday-Friday, no weekends.

The position will remain open until filled.

#AmberSpecialtyPharmacy