Orsini - Rare Disease Pharmacy Solutions
Prior Authorization Specialist - Hybrid- Illinois or Ohio
Orsini - Rare Disease Pharmacy Solutions, Elk Grove Village, Illinois, us, 60009
Prior Authorization Specialist - Hybrid - Illinois or Ohio
Join to apply for the
Prior Authorization Specialist - Hybrid - Illinois or Ohio
role at
Orsini - Rare Disease Pharmacy Solutions .
Salary Range:
$21 – $23 per hour (based on experience).
Position Summary This role partners with the Benefits Verification Team to validate patients’ insurance plans, prescriptions, and eligibility. Primary duties include reading prescriptions, converting them into authorization requests, interpreting medical policies, and contacting physicians to obtain necessary clinical documentation and prior authorizations through insurance plans.
Required Knowledge, Skills & Training
Experience with major medical insurance
Knowledge of pharmacy benefit management
Knowledge of HCPCS codes (J-codes)
Knowledge of ICD-10 codes (diagnosis codes)
Familiarity with medical documentation such as H&P, genetic testing reports, 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 requests sent from BV.
Contact physician’s office to obtain current prescriptions.
Contact physician’s office to obtain required clinical documentation.
Validate that the received documentation meets plan requirements.
Initiate prior authorizations through Cover My Meds.
Follow up on all pending PAs within 48 hours.
Respond to urgent emails from the Patient Care Coordinator Team or Program Manager promptly.
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.
Employee Benefits
BCBSL Medical
Delta Dental
EyeMed Vision
401(k)
Accident & Critical Illness
Life Insurance
PTO, Holiday Pay, and Floating Holidays
Tuition Reimbursement
#J-18808-Ljbffr
Prior Authorization Specialist - Hybrid - Illinois or Ohio
role at
Orsini - Rare Disease Pharmacy Solutions .
Salary Range:
$21 – $23 per hour (based on experience).
Position Summary This role partners with the Benefits Verification Team to validate patients’ insurance plans, prescriptions, and eligibility. Primary duties include reading prescriptions, converting them into authorization requests, interpreting medical policies, and contacting physicians to obtain necessary clinical documentation and prior authorizations through insurance plans.
Required Knowledge, Skills & Training
Experience with major medical insurance
Knowledge of pharmacy benefit management
Knowledge of HCPCS codes (J-codes)
Knowledge of ICD-10 codes (diagnosis codes)
Familiarity with medical documentation such as H&P, genetic testing reports, 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 requests sent from BV.
Contact physician’s office to obtain current prescriptions.
Contact physician’s office to obtain required clinical documentation.
Validate that the received documentation meets plan requirements.
Initiate prior authorizations through Cover My Meds.
Follow up on all pending PAs within 48 hours.
Respond to urgent emails from the Patient Care Coordinator Team or Program Manager promptly.
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.
Employee Benefits
BCBSL Medical
Delta Dental
EyeMed Vision
401(k)
Accident & Critical Illness
Life Insurance
PTO, Holiday Pay, and Floating Holidays
Tuition Reimbursement
#J-18808-Ljbffr