The Prior Authorization Specialist is responsible for workflow - submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Responsible for workflow- submitting retro re billing claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods in timely manner.
Responsible to communicate with facilities regarding all items that are non-covered by an insurance due to retro re billing that have covered alternatives and where allowed file prior authorizations.
Responsible for working with nursing facilities/customer service representative to review charges related insurance
Attention to detail
There is no supervisory responsibility for this position
This position operates in a long-term care facility. This role may use standard office and/or pharmacy equipment such as computers, phones, photocopiers, filing cabinets, rolling carts, fax machines and etc. A large portion of work shall be performed in the long-term care facility where the noise may be loud.
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
May be necessary to work extended hours as needed
May lift and/or move up to 25 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
The is no travel expected for this position
Education and Experience
High school diploma or GED is required.
Must possess or be willing to apply for NJ Pharmacy Technician license
Previous experience working with Long-term care facilities preferred
Professional demeanor with excellent communication skills
Able to work independently as well as in a diverse, team environment
Must have flexibility to work evenings/weekends (2nd / 3rd Shift)
Ability to work at a moderate speed
Must possess strong telephone communication skills and etiquette
Ability to read, write, speak and understand English
Moderate to advanced computer skills required
Knowledge of Medicare Part D, Medicaid, Medicaid HMO plans, & commercial insurances.
Familiarity with resolving Insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non-Covered items.
Entry-level experience with Microsoft Office programs such as Word, Excel, and Outlook.
Behind every script there is a patient. And behind every thriving healthcare facility there is a seamless pharmacy experience. At PharmScript, we are healthcare professionals first. Through precision, persistence and innovation, we seek to earn the trust of providers, residents, patients, and their loved ones every day, with every delivery.
PharmScript is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state or local law.
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