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Prior Authorization Specialist - Remote

Remote:

Full Remote

Work from:

California (USA), Illinois (USA), United States

Offer summary

Qualifications:

Experience with Major Medical Insurance, Knowledge of Pharmacy Benefit and HCPC Codes, Familiarity with medical documentation, Ability to read and convert prescriptions.

Key responsabilities:

Validate patient’s insurance plans and eligibility
Contact physician's offices for documentation and authorizations

Orsini Specialty Pharmacy Pharmaceuticals SME https://www.orsinispecialtypharmacy.com/

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Job description

Description

^{About Orsini Rare Disease Pharmacy Solutions}

^{Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™}

^{Our Mission}

^{Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.}

^{LIVE IT Values}

^{At the heart of our company culture, the Orsini LIVE IT core values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.}

^{Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First}

^{Position Summary
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.}

^{Required Knowledge, Skills & Training}

^{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}

^{Essential Job Duties}

^{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 Patient Care Coordinator 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}