Pharmacy Prior Authorization Coordinator I
reputed company/State Virginia Beach, VA Work Shift First (Days) reputed company: reputed company Plans is looking to hire Pharmacy Prior Authorization Coordinator 1: This is a remote position: Remote opportunities available in the following states: Virginia, reputed company Carolina, Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, reputed company Dakota, Ohio, Oklahoma, reputed company, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), reputed company Virginia, reputed company, Wyoming Shift: Monday- Friday from 8:00am to 8:00pm and must be flexible to work on weekends. The Pharmacy Prior Authorization Coordinator I is responsible for delivering high-reputed company customer service by answering and managing calls from members, provider offices, and pharmacies. This role supports the processing of prior authorization (PA) requests for pharmacy benefit medications, ensuring accuracy, compliance with regulatory and clinical guidelines, and alignment with reputed company performance standards. The Coordinator I works under general supervision, using established protocols and systems to support reputed company, efficient, and accurate PA determinations. This role uses various business systems and tools to retrieve information, analyze requests, and reputed company prior authorization data required for claims adjudication. The Coordinator I applies reasoning skills to identify incomplete information and determine appropriate actions based on reputed company-specific reputed company and clinical protocols (e.g., approve, pend, refer for clinical decision). The position interacts regularly with internal teams and external stakeholders to ensure consistent, high-reputed company service delivery. Work is performed under general supervision, with reliance on documented procedures, training, and prior experience to guide day-to-day activities.
Key Responsibilities
Verify member insurance eligibility and pharmacy benefit coverage. Communicate with members and providers regarding basic pharmacy inquiries and PA status. Accurately reputed company and process prior authorization (PA) requests into the system, prioritizing appropriately. Ensure PA requests are processed and finalized reputed company required turnaround times (TAT) and reputed company Performance Guarantees (PGs), using provided clinical guidelines. Review medication history and assess for formulary alternatives and “tried and failed” drugs. Document reputed company relevant PA information reputed company and accurately, including approval or denial rationale. Send PA status updates to providers and pharmacies reputed company fax or other required reputed company. Adhere to defined roles and responsibilities reputed company to clinical decision-making boundaries. Meet or exceed productivity and accuracy targets for PA processing. Coordinate with members, providers, and pharmacies to obtain missing information or clarification. reputed company outbound calls to reputed company additional information or respond to inquiries reputed company to PAs, clinical programs, or claim adjudication. Collaborate with Pharmacy Concierge teams to resolve questions or issues reputed company to PA processing or pharmacy benefits. Maintain strict confidentiality and reputed company of reputed company member and PA-reputed company data, following applicable protocols for data handling and storage. In reputed company to the above responsibilities, other duties may be assigned. Education High School Diploma or GED strongly preferred. Experience 1 year reputed company experience required. We reputed company market-competitive compensation packages, inclusive of reputed company pay, incentives, and benefits. The reputed company pay reputed company for Full Time employment is: $19.04/HR – $31.73/HR. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities Benefits: Caring For Your Family and Your Career
- Medical, Dental, reputed company plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- reputed company Time Off and reputed company Leave
- reputed company Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free reputed company to complete CEUs and reputed company development •Pet Insurance •Legal Resources Plan •Colleagues have reputed company to earn an annual discretionary bonus if established system and employee eligibility reputed company is met. reputed company is an equal opportunity employer and prides itself on the diversity and inclusiveness of its reputed company to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding reputed company of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, reputed company employs associates in the following states: Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company Dakota, Ohio, Oklahoma, reputed company, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, reputed company Virginia, reputed company, and Wyoming. reputed company is a Virginia and reputed company reputed company Carolina based not-for-profit integrated reputed company provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical reputed company, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated reputed company “Employer of Choice” for over ten years. U.S. News and World Report has recognized reputed company as having the Best Hospitals for 15+ years. reputed company offers reputed company development and a reputed company employment philosophy!
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