Description

Position Overview:

This is a general role that handles the review and processing of prior authorization requests for pharmacy claims while providing exceptional service to TrueScripts’ members. The Prior Authorization Coordinator is responsible for prior authorizations received electronically (ePA), via fax, or by provider or member request. The Prior Authorization Coordinator will verify what documentation has been received and obtain any necessary documentation required by benefit plan parameters per guidance of pharmacist. The Prior Authorization Coordinator will be an expert in the use of PA navigation software and will be responsible for the navigation of all submitted PAs from receipt through clinical review determination. **To be considered for this role applicants must reside in Pacific time zone**

Principal Roles and Responsibilities:

· Complete new/renewal prior authorization requests for specialty & non-specialty drugs with accuracy in a timely manner.

· Reach out to members, pharmacies, and physician offices by telephone, email, and fax as deemed necessary.

· Ensure compliance with benefit plan parameters.

· Educate and assist members with pharmacy benefit plan understanding and prior authorization requests.

· Monitor PA queues to ensure PA requests are updated and processed according to company guidelines.

· Investigate, solve problems, and resolve issues related to prior authorization requests.

· Receive automated clinical review responses from ePA and manual clinical reviews from pharmacists.

· Create and send denial letters to providers.

· Move approved prior authorization to the appropriate Member or Clinical Care queues.

· Perform other duties as assigned.

Qualifications:

· High school diploma required, two-year degree in related field preferred.

· Demonstrated reliable work history.

· Some experience in pharmacy prior authorizations or retail pharmacy experience.

· Effective communication skills with members, physicians’ offices, and pharmacies.

· Ability to learn and explain pharmacy benefit plans to benefit holders.

· Proactive mindset, with ability to work diligently through prior authorizations queues.

· Ability to work independently.

· Proficiency in Microsoft Office 365 (Word, Excel, Outlook, etc.).

· Capacity to multitask and adjust priorities based on business needs.

· Collaborative team player mindset with strong problem-solving abilities, analytical thinking, and attention to detail.

· The drive to learn business processes specific to the Pharmacy Benefit Management (PBM) industry.

Requirements