Prior Authorization Coordinator

🔥 0 minutes ago

🎰 Nevada – Remote

🎰 Nevada – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.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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TrueScripts Management Services

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

TrueScripts Management Services is dedicated to providing exceptional prescription benefit management services. With a focus on delivering maximum savings and amazing care, TrueScripts works closely with members, clients, brokers, and prescribers to offer personalized and customized solutions. The company prides itself on transparency and efficiency, featuring a 24-48 hour turnaround time for prior authorization requests and a commitment to customer service, ensuring that real people are available to assist over 99% of the time.

📋 Description

• Review and process prior authorization requests for pharmacy claims • Provide service to TrueScripts’ members • Handle prior authorizations received electronically, by fax, or by provider/member request • Verify received documentation and obtain required documentation according to benefit plan parameters and pharmacist guidance • Navigate submitted prior authorizations from receipt through clinical review determination using PA navigation software • Complete new and renewal prior authorization requests for specialty and non-specialty drugs • Contact members, pharmacies, and physician offices by telephone, email, and fax as necessary • Ensure compliance with benefit plan parameters • Educate and assist members with pharmacy benefit plans and prior authorization requests • Monitor PA queues and process requests according to company guidelines • Investigate, solve, and resolve issues related to prior authorization requests • Receive automated clinical review responses from ePA and manual clinical reviews from pharmacists • Create and send denial letters to providers • Move approved prior authorizations to the appropriate Member or Clinical Care queues • Perform other assigned duties

🎯 Requirements

• Applicants must reside in the Pacific time zone • High school diploma required • Two-year degree in a related field preferred • Demonstrated reliable work history • Some experience in pharmacy prior authorizations or retail pharmacy experience • Effective communication skills with members, physicians’ offices, and pharmacies • Ability to learn and explain pharmacy benefit plans to benefit holders • Proactive mindset and ability to work diligently through prior authorization queues • Ability to work independently • Proficiency in Microsoft Office 365, including Word, Excel, and Outlook • Ability to multitask and adjust priorities based on business needs • Strong problem-solving abilities, analytical thinking, and attention to detail • Willingness to learn business processes specific to the Pharmacy Benefit Management (PBM) industry

🏖️ Benefits

• Fully remote work arrangement