Senior Prior Authorization Specialist

Immediate need for a talented Senior Prior Authorization Specialist. This is a 06+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-32225

Pay Range: $18 - $19/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• On queue by 8am, strictly an inbound call position.
• On these calls they will be providing prior authorization status, how to submit prior authorization, information gathering, working with pharmacists for call backs with members
• Process a variety of requests, inquiries, and transactions via phone, email, fax, and mail
• Review requests to ensure accuracy
• Support internal and external customers via phone or email
• Document all pertinent information related to calls/inquiries and route unresolved issues to the appropriate area for follow-up
• Gather and analyze data to provide feedback to Team Leads on employee development needs
• Screen inquiries to determine if authorization is required
• Verify member benefits and eligibility and/or provider setup
• Maintain and update Service Requests and research incorrect or missing information
• Triage and assign all incoming inquiries in a timely and efficient manner
• Perform Peer Audits monthly as required
• Provide clinical review outcome notifications to members and providers (verbal and written)

Key Requirements and Technology Experience:

• Pharmacy experience, Prior authorization exp.
• 3+ years of experience in a related field.
• High school diploma or GED.
• Success within the first 30-90 days would be gaining a strong understanding of the team, processes, and performance expectations while building positive relationships with colleagues and stakeholders.

Our client is a leading health insurance and healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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