Prior Authorization Coordinator

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

The Prior Authorization Coordinator facilitates the logging in and out of all prior authorization, appeal and grievance requests, and follow-up on said requests, to ensure that all requests are resolved and completed in a timely manner. The Coordinator ensures that all steps involved with the process are completed and all regulatory requirements are met or exceeded. The Coordinator is also responsible for the Pharmacy Medical Exception Line to address provider questions regarding the formularies for the EGWP PDP and Pharmacy Benefit Dimensions.

The Coordinator may also be assigned to provide high quality, diverse administrative support including but not limited to: faxing prior authorization requests, completing decision letters-faxing and copying, making decision notification phone calls to Member and Physicians, filing, and document scanning preparation. Occasional holidays, weekends and overtime are a requirement of the position.

• High School diploma or GED required; Associates degree preferred.

• Two (2) years of experience in pharmacy and/or health insurance operations required OR total one (1) year non-PBD associate (temporary) experience working within the same positions and/or department required. Pharmacy experience strongly preferred.

• General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred.

• Familiarity with HMO concept, PC skills and pharmacy on-line system preferred.

• Proven written and verbal communication skills.

• Excellent organizational and time management skills

• Excellent ability to absorb new concepts and adapt to a changing environment

• Exhibit creativity and self-motivation, with ability to effectively solve problems as they arise.

• Demonstration of math aptitude for purposes of calculating simple drug requirements when given doses and prices calculations.

• Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

• Prior Authorization, Appeal & Grievance Request Coordination

  • Assist Clinical Review Pharmacist in making appropriate decision by verifying member and provider eligibility and filing requests into the correct member folder. (Standard: 2 minutes per request /all requests will be triaged within 2 hours of receipt)

  • Enter data and ensure complete accuracy on all statistics by logging prior authorization requests into pharmacy systems. (Standard: 3.5 minutes per request / All requests will be logged in by end of business day.

  • Complete the request by entering override into the appropriate pharmacy system and updating all information in required documentation systems. May also include transcribing Medical Director decision into systems. (Standard: 7 minutes per request/all requests will be completed within 24 hours of a pharmacist decision).

• Outreach to members and providers

  • Facilitate follow-up phone calls to members and providers for clinical approvals and denials. (Standard: Follow-up phone calls will be completed within 1 day from the date of denial)

  • Initiate outbound telephone calls to members/physicians regarding decisions within all regulatory time frame requirements.

• Internal Customer Service

  • Answer and provide resolution to provider and member services formulary/prior authorization status questions for all Pharmacy Benefit Dimensions and EGWP PDP through the Medical Exception Line.

• Correspondence

  • Provide Support for all required letters within required timeframes.

  • Fax prior authorization requests including requests for additional information and completed requests.

  • Copy and mail completed requests and related documents.

  • Prepare completed requests for scanning into documentation systems.

  • Maintain proper storage of all files, in accordance with the corporate retention policy.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $21 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.