Prior Authorization Specialist/ Pharmacy Technician

At The Remedy, our Prior Authorization Specialist plays an integral role in the patient intake and billing process. Prior Authorization Specialists use their experience and knowledge of working with insurance companies to complete the verification of benefits and eligibility process, collect the appropriate documentation, and submit prior authorization requests. This position will also work closely with specialty pharmacies to fill prescriptions, and deliver the medication to the clinics. 

Duties/Responsibilities: 

• Contacts payors to obtain and verify insurance benefits and eligibility for behavioral health services using online remotes, eligibility system or by calling directly. 

• Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims. 

• Discusses benefits with patients in advance of appointment to explain the variation between medical and behavioral health benefits so the patient can make an informed decision as to whether to receive treatment. 

• Prepare and submit prior authorization requests to insurance companies including commercial payers and government payers. 

• Requests documentation from providers to acquire prior authorization for services when needed. 

• Organize patient medical records for prior authorization and appeals process when needed. 

• Track and monitor the progress of prior authorization requests, along with all related appeals through and notate in PM/EMR software. 

• Post timely and accurate payor authorization decisions prior to the patient’s service to financially secure the account, promote good patient service, accurate billing and timely reimbursement. 

• Recognize and report trends and patterns with insurance companies. 

• Communicate with patients throughout the process to give updates and answer questions. 
• Work closely with the scheduling teams, clinic leaders, and pharmacies to coordinate care and timely deliveries of medications. 

• Performs other duties as assigned. 

Required Skills/Abilities:  

• Excellent verbal and written communication skills. 

• Excellent interpersonal, negotiation, and conflict resolution skills. 

• Excellent organizational skills and attention to detail. 

• Strong analytical and problem-solving skills. 

• Ability to prioritize tasks and to delegate them when appropriate. 

• Ability to act with integrity, professionalism, and confidentiality. 

• Proficient with Microsoft Office Suite or related software. 

Education and Experience: 

• High school diploma or GED required. Previous customer service experience preferred.  

• Two years of prior authorization experience preferred. 

• Third party payer experience strongly preferred. 

• Electronic Health Record and practice management software experience. 

Physical Requirements:  

• Prolonged periods of sitting at a desk and working on a computer. 

• Must be able to lift up to 15 pounds at times.  

Salary : $21