As one of the largest and most respected specialty pharmacies, BioPlus creates a meaningful difference to our patients, prescribers, payers, and pharmaceutical partners.
Our 2 - Hour Patient Acceptance Guarantee gives a quick response to prescribers and patients for critical, time - sensitive treatments. As we continue to grow, we need exceptionally talented, bright, and driven people. If you would like to help us continue to be the innovative leader in our industry, this is your chance to join our team.
Job DescriptionThe Coverage Determination Rep I is responsible for gathering all information required on an authorization, completing, and submitting the authorization form to insurance company and for all follow up phone calls and documentation of these authorizations.
Responsibilities
Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers.
Review prescription for accuracy of prescribed treatment regimen prior to submission of authorization.
Gather all necessary information from prescriber offices to complete authorization forms.
Notifying appropriate staff of approved/denied medications.
Process/reverse online claims to confirm authorization outcome.
Completes status check with insurance company regarding receipt and outcome of prior authorization.
Perform call to prescriber office for status of authorization or request for additional information.
Responsible for all documentation of authorization statuses into CPR+ progress notes.
Update sales staff with pertinent information.
Participate and perform other duties as assigned by leadership
Skills & Abilities
Positive Attitude
Professional appearance
Work cooperatively and be a liaison between departments when needed
Knowledge of standard medical terminology and pharmacy prior authorization and appeal/denial processes desired
Demonstrate excellent oral, presentation, and written communication skills
Demonstrate proficiency in the use of MS Office software, which includes Excel, Word, and Outlook
Demonstrate the BioPlus C.A.R.T. values.
Qualifications
High School Diploma or Equivalent.
At least 1 year experience working with pharmacy prior authorizations, or pharmacy billing.
Specialty pharmacy experience preferred.
BioPlus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment.
BioPlus is an Equal Opportunity Employer
Top Skills
What We Do
Meet the premiere national specialty pharmacy backing up a ‘fast & easy’ promise with the Power of 2. Part of the CarepathRx family of pharmacy and medication management solutions, BioPlus Specialty Pharmacy offers a 2 Hour Patient Acceptance Guarantee™ so physician offices quickly know whether a referred patient is accepted for treatment. Then prescriptions are on their way with our 2 Day Ready 2 Ship™. Medication refills are an easy 2 clicks away for qualifying prescriptions.
