Specialist I – Prior Authorization

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $20 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Review, process, and troubleshoot incoming Prior Authorization requests for various medications • Accurately process requests according to regulatory and client specific guidelines • Work with team members to meet departmental performance metrics and maintain compliance • Work with clinical staff to ensure requests are processed accurately and timely • Process requests received via phone, fax, and web submission • 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 assist providers with submitting prior authorization requests • Provide formulary product information and communicate 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 personal health information and comply with HIPAA regulations and confidentiality requirements • Utilize downtime for personal and professional development • Maintain scheduled hours and demonstrate flexibility to aid in hour coverage • Perform other duties as assigned

🎯 Requirements

• 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

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750! • eLearning classes • Participation in the Navitus CPhT program