Prior Authorizations Specialist

Position Objective

The Authorizations Program Specialist/Benefits Verification Specialist assists in facilitating completion of authorizations for, or in combination with MDOs (medical doctors’ offices) and/or provides assistance to pharmacies. 

Essential Functions

• Receives case information via the system portal.
• Determines who submitted the case, if case requires help with filling the prescription, or just requires prior authorization assistance.
• Assists in facilitating completion of authorizations for, or in combination with the MDO.
• Communicates via phone with MDOs, retail and specialty pharmacies regarding clinicals, authorizations, transfers and/or follow-ups.
• Documents and makes notations in the system regarding the case information.
• Performs other duties as assigned by the Authorizations Program Supervisor.
• Must exhibit excellent skills in the following areas: verbal/written communication, computer/data entry/software proficiency, interpersonal and relationship-building skills, self-discipline, pro-activeness, attention to detail, and the ability to maintain strict confidentiality.

Performance Responsibilities

Although each position has its own unique duties and responsibilities, the following listing applies to all employees of the organization:  

• Must demonstrate effective communication skills by conveying necessary information accurately, listening effectively and asking questions when clarification is needed.
• Must be able to be depended upon to plan and organize work effectively and ensure its completion.
• Must be able to demonstrate reliability by arriving to work on time and taking breaks in expected timeframes.
• Must record time at the start of the shift and at the end of the shift (and non-exempt employees must also record time out before a meal period, and when they return from a meal period).
• Must meet all productivity requirements in expected timeframe or deadline.
• Must be able to demonstrate initiative and strive to continually improve processes and relationships.
• Ensure all activities in accordance with companywide information security policies and procedures as per ISO 27001 and 9001 requirements.

Knowledge, Skills & Abilities

• Graduation.
• Pharmacy Technician Certification, preferred, but not required.
• 1-3 years’ pharmacy experience (aside from internships), preferred (retail or specialty pharmacy experience, a plus).
• 1-3 years' experience in the medical/healthcare field (i.e. hub services, pharmacy, doctor's office, hospital administration, etc.), preferred.
• Superior level of customer service, interpersonal skills, and highly effective in working objectively with a diverse group of people.
• Excellent verbal/written communication skills, self-discipline, and attention to detail.
• Proficient in data entry, computer skills, and able to learn the department’s software system.
• Must be a team player willing to accept organizational and team goals, and function with minimal supervision.
• Adaptable, able to shift gears and focus based on company and team needs.