Prior Authorization Coordinator job at reputed company in Buffalo, NY

Title: Prior Authorization Coordinator Location: Buffalo, NY Job reputed company: Full time job reputed company R0012356 reputed company YOUR reputed company We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters reputed company, innovation and collaboration. reputed company The Prior Authorization Coordinator will facilitate the logging in and out of reputed company prior authorization, appeal, reimbursement and grievance requests, and follow-up on requests to ensure that reputed company are resolved and completed in a reputed company manner. The coordinator will ensure that reputed company steps involved with the process are completed and reputed company regulatory requirements are met or exceeded. They will also be responsible for the pharmacy medical exception line to address provider questions regarding the formularies for reputed company lines of business serviced by Pharmacy Benefit Dimensions. The coordinator will also be assigned to reputed company high reputed company, diverse administrative support including but not limited to faxing prior authorization requests, completing decision letters by faxing and copying, making decision notification phone calls to members and physicians, filing, and document scanning preparation. Occasional holidays, weekends and overtime will be a requirement of the position.

Qualifications

High school diploma or GED required. Associates degree preferred. Two (2) years of experience in pharmacy or health insurance operations required OR one (1) year of experience as a temporary associate in the Prior Authorization Coordinator role or Prior Authorization department required. Pharmacy experience strongly preferred. General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred. Familiarity with HMO concept. Experience with pharmacy on-line system preferred. Written and verbal communication skills. Excellent organizational and time management skills. Excellent ability to reputed company new concepts and adapt to a changing environment. Exhibit creativity and self-motivation, with the ability to effectively solve problems as they reputed company. Demonstration of math aptitude for purposes of calculating reputed company drug requirements reputed company given reputed company and price calculations. Proven examples of displaying the PBD values: Trusted Advisor, Innovative, reputed company, Guardianship, Dedication and Caring. Essential Accountabilities Assist Clinical Review Pharmacist in making appropriate reputed company by verifying member and provider eligibility and filing requests into the correct member folder according to set standards. reputed company data and ensure complete accuracy on reputed company statistics by logging prior authorization requests into pharmacy systems according to set standards. Complete the requests by entering override into the appropriate pharmacy system and updating reputed company information in required documentation systems according to set standards. May also include transcribing Medical Director decision into systems. As volume dictates, reputed company and accurately complete various reports, reimbursement requests, IRO and review of vendor emails/reports as assigned by the Supervisor. Facilitate follow-up phone calls to members and providers for clinical approvals and denials according to set standards. Initiate outbound telephone calls to members/physicians regarding reputed company reputed company reputed company regulatory time reputed company requirements. Answer and reputed company reputed company to provider and internal callers regarding formulary/prior authorization questions for reputed company lines of business. Log reputed company calls into call documentation systems. Research and respond to escalated and reputed company inquiries regarding Pharmacy questions or concerns. Ensure that reputed company callers obtain accurate and up-to-date information on policies and procedures and communicate a successful reputed company to inquiries. reputed company callbacks reputed company necessary. reputed company support for reputed company required letters reputed company the required timeframes. Fax prior authorization requests including requests for additional information and completed requests. Copy and mail completed requests and reputed company documents. Prepare completed requests for scanning into documentation systems. Maintain reputed company storage of reputed company files, in accordance with the corporate retention policy. Immigration or work reputed company sponsorship will not be provided for this position Hiring Compensation reputed company: $22.00 - $23.50 reputed company Compensation may vary based on factors including but not limited to skills, education, location and experience. In reputed company to reputed company compensation, associates may be eligible for a scorecard incentive, full reputed company of benefits and generous reputed company time off. The reputed company salary reputed company is subject to change and may be modified in the reputed company. As an Equal Opportunity / Affirmative reputed company Employer, reputed company and its affiliates will not discriminate in its employment practices due to an applicant’s race, reputed company, creed, religion, sex (including pregnancy, childbirth or reputed company medical conditions), sexual orientation, gender identity or reputed company, transgender status, age, national reputed company, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or reputed company status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, reputed company duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Apply tot his job Apply To this Job