Prior Authorization Coordinator

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Regular Full Time Professional US

20 days ago Requisition

We are a small, but rapidly growing PBM. Our culture is important to us, so teamwork and open/honest communication are critical to maintain a balanced work/life schedule. Most importantly, we encourage you to have fun, maintain humor in your workday, and set that example for your team. At Verus Rx, we believe deeply in diversity and all of the fascinating characteristics that make us each unique.

We are focused on equality, inclusion, and keeping up with a modern and progressive approach.

Verus Rxis a certified “Great Place to Work”,united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence.

This position is responsible for accurately processing prior authorizations in the prior authorization software, primarily finalizing PA determinations with data entry as needed. This position requires the employee to provide quality customer service to internal and external customers via e-mail or phone correspondence. The successful prior authorization coordinator is a detail-oriented, strong communicator and is an organized problem solver. Able to work independently and collaboratively with internal team members and external plan participants.

Must be results-oriented with a positive attitude and able to manage time skillfully.

• Assist with calls transferred from Member Service Representatives (MSRs) for prior authorization-related issues; research and resolve questions from members, providers, pharmacies, and other callers, including explaining PA denials.
• Document callers’ questions, issues, and resolution in the CRM (Dynamics).
• Send outbound PA request forms via fax to provider offices to initiate prior authorizations and follow up by phone as needed to obtain required clinical documentation.
• Respond to emails to initiate prior authorizations and address PA status inquiries from internal and external stakeholders (e.g., providers, members, internal teams).
• Finalize PA orders following clinical review by a Pharmacist or PA Technician, documenting the decision in the CRM (Dynamics) and entering overrides upon approval.
• Monitor assigned queue(s) and case volume to help meet turnaround time (TAT) targets.

• Meet and/or exceed production, quality, attendance, and adherence standards.
• Perform other duties as assigned.
• Minimum of 2 years’ experience in PBM or related (retail or hospital pharmacy)
• Ability to work cooperatively
• Ability to master computer/software applications necessary for completing job tasks as required.
• Ability to understand functionality of applications for processing PA reviews (data entry).

None.

The noise level in the work environment is usually low to moderate.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls.

The employee is occasionally required to stand, walk; sit; and reach with hands and…