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Posted 6 days ago
Requirements and responsibilities
Job Title: Prior Authorization Specialist
Duration: 6 plus month with possible extension
Location: Fully remote
Pay Range: $20-$26.00/hr
The Clinical Operations Consultant fulfills the company purpose of helping people on their path to better health by driving quality execution of administrative support for Prior Authorization.
The Clinical Operations Consultant will be a Prior Authorization system Subject Matter Expert providing support for the Prior Authorization/Appeals Operational and Administrative teams.
Daily Configuration & Document Management
Configure client setup into the Prior Authorization system ensuring accuracy and completeness
Validate all configurations for compliance and operational standards
Assist in research of general cases submitted to the department
In order to be successful in this role you will interact and collaborate with internal colleagues to identify opportunities to improve processes and drive efficiencies within the department as well as assist in leading meetings, creation and maintenance of work instructions, training, projects and activities related to PA systems.
Required Experience:
-3+ years of Pharmacy Benefit Management (PBM) prior authorization experience)
Preferred Qualifications:
-Experience with PA system setup
-Experience with MS Excel, Word and PowerPoint
-Experience with CAS and/or MedHOK systems
-Experience with Prior Auth and Appeals activities
-Experience with previous project management.
Education: Bachelor's Degree in any related field
Verifiable High School Diploma, GED, or equivalent
Optionally, you can add more information later (benefits, pre-screening questions, etc.)