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    Prior Authorization Specialist - Philadelphia, United States - ParetoHealth

    ParetoHealth
    ParetoHealth Philadelphia, United States

    1 week ago

    Default job background
    Part time
    Description

    We're in this for the greater good at ParetoHealth. Our mission is collective greatness, nothing less will do. Our team is a single force united in the drive to transform employee health benefits.

    The company was founded in 2011 to help small and medium-sized businesses fight the rising cost of employee health benefits. We blazed the trail with financing innovations that reduce the risks in self-insurance and deliver significant savings-and we continue to lead with a growing ecosystem of partners and world-class cost control solutions.

    But success is measured by more than dollars alone and we measure ours by the good that comes from knowing that every client and all their employees can count on effective, affordable healthcare for years to come.

    Position Summary:

    As a Prior Authorization Specialist, your primary responsibility is to assist in the prior authorization process for prescription medications. You will work under the supervision of licensed pharmacists and collaborate with healthcare providers, insurance companies, and patients to ensure timely approval for medications requiring prior authorization. This will be a part-time, Monday-Friday, 5pm-9pm EST position.

    Key Responsibilities:

    • Review Prescriptions: Review prescriptions requiring prior authorization according to PBM guidelines.
    • Gather Patient Information: Collect necessary patient information, including medical history, and demographic data.
    • Complete Prior Authorization Forms: Fill out prior authorization forms accurately and completely, ensuring all required information is included.
    • Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain additional documentation or clarification as needed to support prior authorization requests.
    • Submit Documentation: Submit prior authorization requests along with supporting documentation to PBMs via appropriate channels.
    • Document Process: Maintain accurate records of prior authorization requests, approvals, denials, and any correspondence related to the process.
    • Assist Pharmacists: Assist licensed pharmacists with other pharmacy duties as needed.
    Required Skills & Qualifications:
    • Enrollment in an accredited pharmacy program leading to a Doctor of Pharmacy (Pharm.D.) degree.
    • Knowledge of pharmacy terminology, medication classes, and therapeutic uses.
    • Familiarity with insurance plans, prior authorization procedures, and healthcare regulations.
    • Excellent communication and interpersonal skills.
    • Attention to detail and ability to maintain accuracy in documentation.
    • Strong organizational and time management abilities.
    • Ability to work effectively in a team environment and collaborate with healthcare professionals.
    • Proficiency in using computer software for data entry and communication.
    Pareto Perks:

    Pareto offers a competitive compensation package commensurate with skills and experience. In addition, Pareto offers a robust benefits package including Medical (100% employer paid), Dental, Vision, STD/LTD, and employer 401(k) contribution.

    What We Live By:

    1. Get it Done and Get it Done Right - We crank out work at higher rates and at a higher quality than our peers in the industry. Our ability to do a lot with a little is a driving force behind Pareto Health, one that's made our brand synonymous with class, quality, and extreme competence.

    2. Fire in the Belly - We only make time for champions; we only consider those with an inner desire to excel and push things forward. Our team, our partners, our members-everyone in the Pareto Health universe-works hard, learns constantly, improves furiously, and does so with a fire in the belly.

    3. See the Field - As you're stuck thinking about tomorrow, we're already on to thinking about next year. Pareto Health embodies a culture of anticipation, perception, and acting with intent. In one-on-ones, in meetings, at a company level, and at an industry level, we're always two steps ahead.

    4. For the Greater Good - Our vision extends past the here and now. We're rowing in the same direction toward the common goal of transforming an industry. It's our accountability, teamwork, and responsibility that ensure as we're changing industry tides, we're helping them rise. Now watch as we lift all boats in the process.

    Disclosures:

    ParetoHealth is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, subcontractors, vendors, and clients.

    California Applicants: See Pareto's CCPA Notice of Collection for California Employees and Applicants for information about how Pareto Captive Services, LLC, Pareto Health, LLC, and Pareto Underwriting Partners, LLC, together with their respective subsidiaries (collectively, "Pareto") collects and uses personal information submitted by employment applicants.
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