Prior Authorization Specialist - Remote

REQUIRED KNOWLEDGE, SKILLS & TRAINING

• Experience with Major Medical Insurance.
• Knowledge of Pharmacy Benefit
• Knowledge of HCPC Codes (J-Codes).
• Knowledge of ICD-10 Codes (Diagnoses Codes).
• Familiar with medical documentation such as H&P’s, Genetic testing, etc.
• Ability to read prescriptions.
• Ability to convert a prescription into an authorization request based on payer requirements.
• Ability to interpret medical policies.
• Prior pharmacy experience preferred

ESSENTIAL JOB DUTIES

• Contact plans (PBM or Major Medical) to validate request sent from BV.
• Contact physician’s office to obtain current prescriptions.
• Contact physician’s office to obtain clinical documentation that is required  by the plans.
• Validate that the clinical documentation received is what is required by the plan.
• Initiate prior authorizations through Cover My Meds.
• Follow up on all pending PA’s within 48 hours.
• Respond to urgent emails submitted by the PCC Team or Program  Manager in a timely manner.
• Obtain approval/ denial letters.
• Submit all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.
• Initiate re-authorizations that are set to expire 30 days prior to the term date.

EMPLOYEE BENEFITS

• BCBSL Medical
• Delta Dental
• EyeMed Vision
• 401k
• Accident & Critical Illness 
• Life Insurance
• PTO, Holiday Pay, and Floating Holidays
• Tuition Reimbursement