Prior Authorization Spec. - On Site first 6 months then hybrid

POSITION SUMMARY:

The Prior Authorization Specialist is primarily responsible for obtaining insurance authorizations and verifying insurance benefits for patients that require specialty medications for chronic illnesses. The Prior Authorization Specialist must have good organizational skills with attention to detail, excellent customer service technique, and patient rapport. The Specialist must be able to work and interact as part of a team and be a patient advocate.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Obtains pre-authorization/pre-certification per payer requirements for services rendered and ensures authorization information is documented appropriately in the system.
• Verify patient insurance benefits for all assigned patients within program required timeframes.
• Assesses and refers appropriately for special ancillary programs (Voucher, Coupon, PAP) and based on determination follows through to appropriate conclusion.
• Collaborates with physician offices, management department, etc. to ensure that accurate information is collected and distributed effectively and efficiently.
• The Specialist creates and maintains a daily report that tracks the activity of all open referrals.
• Daily communication is maintained with patients, payers, and physician offices regarding program status and financial responsibility.
• Remains current with insurance requirements for pre-authorization.
• Maintains a professional atmosphere at all time with patients, family members and staff.
• Act as single point of contact for an assigned group of prescribers. Effective and timely communication with prior authorization and/or patient enrollment status.
• Complete accurate entry of billing information to ensure timely payment and avoid delay in patient therapy.
• Communicate with payers for claim rejection resolution.
• Accurate and timely documentation of payer, billing information and patient status within the operations systems.
• Comply with HIPAA and other federal, state, and local regulations as well as maintain the highest degree of confidentiality in client and staff matters

EDUCATION AND EXPERIENCE:

• High diploma or equivalent required, Associates degree preferred.
• 2 years of relevant experience in working in medical health insurance preferred.
• Strong critical thinking and problem-solving skills required.
• Capacity to work with limited supervision and support, in a rapidly changing and fast paced environment.
• Strong capabilities with gathering and analyzing information skillfully while exhibiting sound and accurate judgment.
• Must have demonstrated experience to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manual.
• Proficient with Microsoft Word, Excel, Outlook and general internet
• Multi-tasking skills with the ease of changing direction upon request and need.
• Ability to work in a team-oriented environment communicate effectively and demonstrate sensitivity to clients, visitors, and staff.
• Bi-lingual a plus

ABOUT PARKWAY PHARMACY

Parkway Pharmacy is a leading regional provider of specialty pharmacy services, located in Howell, New Jersey. Parkway Pharmacy offers a broad range of healthcare products and services for individuals with chronic health conditions, such as Crohn’s Disease, Hepatitis C, Oncology, IVIG and Generalized Immune Disorders, Transplant and Rheumatoid Arthritis. Parkway Pharmacy provides comprehensive patient management services including clinical case management programs, counseling, education, outcomes measurement, verification of Medical and Prescription Benefits, prior authorization initiation and reimbursement services.

Parkway Pharmacy is committed to providing equal employment opportunities to all employees and applicants without regard to race, religion, color, sex, national origin, citizenship status, uniform service member status, age, disability, sexual and gender orientation, genetic information or any other protected status in accordance with all applicable federal, state and local laws. This commitment extends to all aspects of the company’s employment practices including, but not limited to, recruiting, hiring, promoting, transferring, compensation, benefits, training, leaves of absence, termination, and other terms and conditions of employment.

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• High school or equivalent (Required)

Experience:

• Medical Insurance verification: 1 year (Required)
• Medical billing: 1 year (Required)

Work Location: Hybrid remote in Township of Howell, NJ 07731