Prior Authorization Specialist
On-siteLouisville, Kentucky, United States
Job Summary
Ensure accurate and timely completion of client prior authorization and therapy change paperwork by collaborating with prescribers and facility contacts. Follow up on all claims requiring prior authorization within four to five business days, track and review claims in QuickBase, and send weekly Excel tracking spreadsheets to the Director of Pharmacy. Compare system reports of unbilled claims to ensure follow-up, assist the Billing Department with month-end resolutions, and adjudicate claim rejections. Utilize Frameworks, QuickBase, Docutrack, and CoverMyMeds for daily workflows. Work Monday through Friday from 8:30 am to 5 pm.
Required Qualifications
- High School Diploma/General Education Diploma
- Proficient with Microsoft Word & Excel
- Experience in healthcare billing environment (pharmacy preferred)
- Familiarization with on-line claims processing and Medicaid and Medicare billing practices
Desired Qualifications
- Kentucky Pharmacy Technician License
- Ability to prioritize and meet pre-determined deadlines
- Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
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