Prior Authorization Staff

The Prior Authorization Staff plays a crucial role in ensuring timely and accurate authorization for patient infusions. This position requires meticulous attention to detail, effective communication skills, and a commitment to patient advocacy. The successful candidate will be responsible for submitting clinical information, following up on denials, coordinating with pharmacies, and monitoring infusion schedules to ensure all necessary authorizations are in place.

Job Details:

• Work from Home
• 08:00 AM - 05:00 PM EST (08:00 PM - 05:00 AM Manila Time)

Responsibilities:

• Submit accurate clinical information to obtain prior authorization for patient infusions.
• Follow up on denials by submitting appeals and scheduling peer-to-peer discussions when necessary.
• Review and submit prescriptions to pharmacies in accordance with prior authorization requirements.
• Monitor infusion schedules and confirm that all required authorizations are on file prior to patient appointments.
• Collaborate with healthcare providers and insurance companies to ensure seamless authorization processes.
• Utilize CoverMyMeds software efficiently to streamline prior authorization procedures and enhance productivity.
• Maintain detailed records of authorization activities and communicate updates to relevant stakeholders as needed.

Qualifications:

• Previous experience in medical prior authorization is required.
• Familiarity with CoverMyMeds software is advantageous.
• Strong organizational skills and attention to detail are essential.
• Excellent communication and interpersonal abilities.
• Ability to work independently and prioritize tasks effectively.
• Knowledge of healthcare regulations and insurance policies related to prior authorization processes.