Orsini Specialty Pharmacy · 1 day ago
Prior Authorization Specialist - Remote
Elk Grove, Illinois, United States
Full-time
Remote
Entry Level
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Responsibilities
Contact plans (PBM or Major Medical) to validate request sent from BV.
Contact physician’s office to obtain current prescriptions.
Contact physician’s office to obtain clinical documentation that is required by the plans.
Validate that the clinical documentation received is what is required by the plan.
Initiate prior authorizations through Cover My Meds.
Follow up on all pending PA’s within 48 hours.
Respond to urgent emails submitted by the PCC Team or Program Manager in a timely manner.
Obtain approval/ denial letters.
Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process.
Initiate re-authorizations that are set to expire 30 days prior to the term date.
Qualification
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Required
Experience with Major Medical Insurance.
Knowledge of Pharmacy Benefit.
Knowledge of HCPC Codes (J-Codes).
Knowledge of ICD-10 Codes (Diagnoses Codes).
Familiar with medical documentation such as H&P’s, Genetic testing, etc.
Ability to read prescriptions.
Ability to convert a prescription into an authorization request based on payer requirements.
Ability to interpret medical policies.
Preferred
Prior pharmacy experience preferred.
Benefits
BCBSL Medical
Delta Dental
EyeMed Vision
401k
Accident & Critical Illness
Life Insurance
PTO, Holiday Pay, and Floating Holidays
Tuition Reimbursement
Company
Orsini Specialty Pharmacy
Providing patients with comprehensive and compassionate care since 1987, Orsini is the leading, independent specialty pharmacy focused on rare diseases, gene therapies, and complex conditions.
Founded in 1987Elk Grove Village, Illinois, USA
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2019-02-06Acquired· undefined
Leadership Team
Michael Fieri
Founder and Chief Executive Officer
Recent News
2023-12-24
2023-12-24
Company data provided by crunchbase
