Patient Care Specialist - Data Entry and Prior Authorization

Qualifications: 

Active Pharmacy Technician License required

Active Pharmacy Technician Certification required (PTCB, ExCPT or Grandfathered)

1. Experience with ALL Major insurances (PBM) 
2. Aetna
3. BCBS (Prime)
4. United healthcare (optum) 
5. Caremark 
6. ESI (express scripts) 

Able to read, understand and translate medical charts into the prior authorization format. 

Understand Pharmacy Benefits and Deductibles.

Understands diagnosis codes: icd10 codes and how to better utilize them.

Can properly navigate through Cover My Meds to properly fill out forms with medical chart info or Patient medical history.

Able to read and translate Pharmacy scripts. 

Must be employed at least 6 months with the organization.

Responsibilities 

Calling patients and providers to obtain clinical information needed to complete prior authorization if none provided on script or original fax. 

Effectively and efficiently fill out prior authorization forms without missing details. 

Following up with insurance for outcomes of the prior authorizations based on submission date and ability to stay on task based on required. completion date. 

Need to be detail oriented.   

Replying to sales inquiries and inquiries from team members to provide updates or handling customer service calls based on status or doctors’ office calling to update or provide requirements. 

Completing prior authorizations within a 14-day time frame or earlier based on supervisors’ expectations.

Must meet perfect attendance and able to rotate through shifts to allow a team member to always be available during hours of operation.