A Prior Authorization (PA) pharmacy coordinator is responsible for supporting the PA pharmacist team and assures the PA pharmacists has all of the necessary information and resources needed to perform a clinical review. The PA Coordinator duties includes receiving incoming PA’s, monitoring the queue’s, faxing final approvals and denials to prescribers and or members. This is a fast-paced dynamic environment.

This is a remote position, Monday-Friday and may include some Saturday’s.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Types, mails, and logs denial and appeal and complaint letters.

Generates reporting data for the health plans regarding denials, appeals and complaints on a monthly basis.

Maintains filing system for denials, appeals and complaints.

Accepts incoming calls and screens or resolves calls in accordance with plan design and authorization requirements.

Enters authorizations for services as delegated by assignment.

Runs and distributes reports from PA data bases including authorization letters, daily authorization reports sent to health plans, and monthly statistical reports for management.

Creates and designs forms and reports as needed.

Maintains UM Committee minutes and updates UM Policy & Procedures as needed.

Determines eligibility and screening incoming pharmacy prior authorization requests for all required documents

Prepares, organizes, and distributes pharmacy prior authorization requests for review by pharmacist/physician and responding to pharmacist/physician requests for additional information

Collects relevant medical information (via telephone, fax, and portal) and applying the appropriate PA criteria

OTHER DUTIES AND RESPONSIBILITIES:

• Assists supervisors with special projects as needed.

• Performs other duties as assigned.

• Maintains departmental data entry manual and edits content and updates format as needed.

• Maintains files.

• Provides desktop support to the department.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Outstanding organization skills and keen eye for detail

• Ability to work in a dynamic and fast-paced environment

• Proficient with MS Office applications- Word, Power Point, Excel, and Access

• Strong ability to use and learn new technology tools

• Capable of working independently with minimal supervision and also as part of a team

EDUCATION and/or EXPERIENCE

• High School or College education a plus

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Choose appropriate

• For this position the percentage of expected Travel is: 10% of the time