Prior Authorization Coordinator

Overview

1267 Professional Pkwy, Gainesville, GA 30507, USA

Pro Care Rx is an Equal Opportunity Employer.

• Process authorizations electronically, utilizing PA and payer portals, fax or telephone, working with payers to secure authorizations.
• Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.
• Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted authorizations.
• Maintain clear communication and documentation with provider offices, patients and pharmacy account managers.
• Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, and follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.
• Input accurate and clear data entry of call logs, important case notes and authorization details into the CRM system.
• Verify the accuracy and quality of data entry within authorizations prior to submission.
• Ability to confirm whether a therapy is complete and if an authorization renewal is needed.
• Initiate and follow-up on authorization renewal requests as assigned.
• Safeguard, protect, and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and company policies/procedures.
• Assess, prioritize and resolve client issues using good listening and comprehension skills.
• Work cooperatively and provide coverage for responsibilities of co-workers when assigned or as needed.
• Assist Reimbursement Director in supervising, guiding, and continual training of PA Coordinators.
• Demonstrate working knowledge of all facets of the role, relevant regulations and organizational and departmental policies & procedures.
• Escalate issues to management as appropriate.
• Perform other duties as assigned to support the business.

• Strong understanding of medical terminology, insurance plans and authorization processes.
• Bilingual English/Spanish is a plus.
• Minimum 3 years of pharmacy or healthcare experience required.
• Minimum 1 year of management experience of a team of 5 or more employees.
• Working in a fast-paced environment for 3+ years is required.
• Ability to manage cases from multiple clientele programs and follow program business rules.
• Proficiency with data entry functions and Microsoft applications required.
• Ability to work independently and on a team.
• Excellent communication, problem solving and customer service skills.
• Strong organizational/interpersonal skills; attention to detail and the ability to multitask proficiently.
• Ability to use multiple PC monitors and navigate through several software systems effectively.

• High School Graduate required, College degree preferred.
• State Pharmacy Technician registration or PTCB National Certification preferred.

• Requires sitting, standing, and occasional light lifting.

Pro Care Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our recruitment team at

Pro Care Rx is an Equal Opportunity Employer.

Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.