Prior Authorization - Baldwin Park, United States - Polaris Pharmacy Services

Polaris Pharmacy Services

Verified Company

Baldwin Park, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

PRIOR AUTHORIZATION SPECIALIST

OVERVIEW

The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers.

The Prior Authorization Specialist must be responsive and courteous when addressing our customers needs.

Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect.

RESPONSIBILITIES

Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers
Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
Contact providers and/or customers as necessary to obtain additional information
Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes
Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner
Review and work convert billing exception reports to ensure claims are billed to accurate financial plans
Complete billing transactions for nonstandard order entry situations as required
Support training needs
Prepare and maintain reports and records for processing
Perform other tasks as assigned.
Follow all applicable government regulations, including HIPAA
Comply with departmental policies regarding safety, attendance, and dress code
Overtime, holidays, and weekends may be required and/or expected
Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
Other duties as assigned; Job duties may vary depending on business needs

Qualifications:

QUALIFICATIONS

High School diploma or equivalent required
Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (longterm care pharmacy preferred)
Framework LTC & General computer knowledge & 10key Number Entry preferred
Able to read, write, speak, and understand the English language
Able to work in a fastpaced 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
Resultsoriented
Good organization/Attention to detail
Reliable
Problem solver
Able to work various shifts and days
Adaptability to an everchanging environment

PHYSICAL DEMANDS
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
May be necessary to work extended hours as needed
May lift and/or move up to 50 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY
We provide qualifying full-time employees with 23 PTO (Paid Time Off) days annually. PTO is used for holidays, vacation, sick leave, and personal leave.

Please note we are a long-term care pharmacy open 24-hours a day, 7 days a week. And schedules may change as determined by the needs of the business.

BENEFITS for full-time employees