Prior Authorization Specialist - Remote

 

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Description

Orsini Specialty Pharmacy is a nationwide specialty pharmacy focused on providing exceptional care to patients throughout their journey. We focus on disease programs that require a high-touch patient experience and provide those we care for genuine empathy and compassion as part of our service delivery.

POSITION SUMMARY
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Specialists are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.

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

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