Prior Authorization Specialist

Job not on LinkedIn

🔥 17 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Polaris Pharmacy Services

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2015

💼 Consulting

🏭 Manufacturing

📦 Logistics

Consulting • Manufacturing • Logistics

Polaris Pharmacy Services is a privately owned long-term and post-acute care pharmacy committed to delivering high-quality pharmacy services, exceptional customer experiences, and industry-leading value. Founded in 2015, Polaris is the 5th largest LTC pharmacy in the U. S. , operating 21 pharmacies across 29 states and serving over 80,000 residents. They provide innovative solutions in specialty pharmacy, pharmacy technology, packaging, reimbursement, workflow, and financial performance.

📋 Description

• Manage and identify a portfolio of rejected pharmacy claims • Research, analyze, and resolve rejected claims with Medicare Part D plans, third-party insurance companies, and state Medicaid plans • Perform edits and reversals to secure claim approvals and maximize payer reimbursement • Contact providers and facility contacts to obtain additional information • Monitor and resolve revenue at risk related to payer setup, billing, rebilling, and reversal processes • Identify, document, communicate, and resolve payer and billing trends and issues as part of a team • Complete, communicate, and submit prior authorization forms promptly • Support training needs • Prepare and maintain processing reports and records • Follow applicable government regulations, including HIPAA • Comply with departmental safety, attendance, and dress-code policies • Conduct responsibilities according to the company Code of Business Conduct and Ethics, policies, Corporate Compliance Agreement, federal and state laws, and professional standards • Perform other assigned duties as business needs require

🎯 Requirements

• High School diploma or equivalent required • Minimum of one or more years working as a pharmacy technician in a retail environment preferred; long-term care pharmacy preferred • Framework LTC and general computer knowledge preferred • 10-key number entry preferred • Able to read, write, speak, and understand English • Able to retain a large amount of information and apply that knowledge to related situations • Able to work in a fast-paced environment • Basic computer knowledge skills required • Basic math and analytical skills • Experience with alphanumeric data entry • Proficient in Microsoft Word, Excel, and Outlook required • Customer service skills • Results-oriented • Good organization and attention to detail • Reliable and able to solve problems • Able to work various shifts and days • Adaptability to an ever-changing environment • May need to work overtime, holidays, and weekends • May sit or stand seven to ten hours per day • May lift and/or move up to 30 pounds • Must follow HIPAA, applicable laws, company policies, and professional standards

🏖️ Benefits

• Paid holidays: 6 days annually • 5 sick days annually • Up to 10 PTO days annually, with rollover options and milestone bonuses • Option to cash out up to 10 PTO hours each quarter • Medical, Dental, and Vision insurance • 401(k), available for part-time and full-time employees • Company-paid life insurance • Short-term and long-term disability insurance • Tuition reimbursement • Competitive pay with annual performance reviews and merit-based raises • Career growth potential • Annual on-site voluntary flu vaccines • Employee referral bonus program

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