The Specialist I, Prior Authorization (PAS) will review, process, and troubleshoot incoming Prior Authorization requests for various medications. The Specialist I, Prior Authorization (PAS) will accurately process the requests according to regulatory and client specific guidelines. The PAS will work with other team members to meet the departmental performance metrics and maintain compliance. The PAS will work with clinical to ensure requests are processed accurately and timely. The PAS will process requests that come in via phone, fax, and web submission.
Is this you? Find out more below!
ResponsibilitiesHow do I make an impact on my team?
- Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit
- Communicate prior authorization criteria to providers
- Act as a provider help desk specialist to aid providers in submitting prior authorization requests, providing formulary product information, and communicating prior authorization request status
- Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs
- Participate in ad hoc or regularly scheduled Prior Authorization projects or projects for other Navitus departments
- Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
- Utilize work down time for personal and professional development through such activities eLearning classes, participation in the Navitus CPhT program, and by continually reviewing all available resources used in prior authorization processing
- Maintain scheduled hours and demonstrate flexibility to aid in hour coverage
- Other duties as assigned
What our team expects from you?
- A high school degree or equivalent. Post high school education desired such as L.P.N., Certified Pharmacy Technician, Medical Terminology, or Medical Transcriptionist
- Previous customer service experience required
- Previous data entry experience preferred
- Experience in health insurance/pharmacy insurance or managed care organization preferred
- Prior authorization processing experience desired
- Experience in a PBM or managed care call center desired
- Experience in a mail or retail pharmacy setting desired
- Experience with Medicare and/or Medicaid regulatory guidance desired
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Location : AddressRemote Location : CountryUSSkills Required
- High school diploma or equivalent
- Previous customer service experience
- Compliance with program objectives and regulations
- Ability to interact cooperatively and respectfully with employees
- Post-high-school education such as LPN, Certified Pharmacy Technician, medical terminology, or medical transcription
- Previous data entry experience
- Experience with health insurance, pharmacy insurance, or managed care organizations
- Prior authorization processing experience
- Experience in a PBM or managed care call center
- Experience in a mail or retail pharmacy setting
- Experience with Medicare or Medicaid regulatory guidance
What We Do
A leading applied technology services company, we innovate to deliver service excellence and successful outcomes across sales, delivery and development. With our strategy to be agile, nimble and customer-centric, we anticipate the future of applied technology and predict tomorrow’s trends to keep our clients at the summit in an ever-changing marketplace. Leading with architecture and design, our next-gen solutions enable enterprises to accelerate on their digital transformation journey.
