Duly Health and Care
Pharmacy Prior Authorization Tech
Duly Health and Care, Downers Grove, Illinois, United States, 60516
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Benefits
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to community engagement and social impact.
Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
Position Highlights
Full-Time, 40 hours/week
Location: Downers Grove
Responsibilities
Data Collection and Documentation 40%
Receives and documents telephonic and/or electronic requests for medications requiring prior authorization from Primary Care Physicians, Specialists, and Ancillary providers.
Verifies member eligibility and basic benefit coverage levels including coordination of benefits and third‑party liability.
Utilizes internal and external resources to determine provider networks.
Evaluates each Prior Authorization request to ensure all required information, codes, place of service, and provider details are available for submission.
Investigates and obtains missing medical information from providers.
Maintains accurate documentation and follows patient privacy in accordance with HIPAA and Duly policies.
Interface with Health Plans and Provider offices 40%
Contacts physician offices, pharmacies, review organizations, and insurance companies for prior approval requirements and to submit appropriate forms.
Provides ongoing education to physician offices regarding prior authorization processes and requirements.
Maintains current knowledge of all health plan carrier requirements related to prior authorizations and approval paths.
Applies clinical knowledge, health plan formularies, ICD‑10 and CPT coding, and medical terminology for communication with physicians and providers.
Serves as a resource to physician/provider offices regarding prior authorization requirements and alternative medication availability.
Provides timely notifications of approval or denial decisions through designated communication routes.
System entry and other functions 20%
Performs data entry and processing of prior authorization requests through the EPIC system and edits notes per department guidelines.
Maintains accurate prior authorization notes and patient chart documentation entries.
References Team Lead or Supervisor/Manager for review of complex requests.
Provides input to management regarding improvements to operating practices.
Assists with orientation and training of new staff.
Qualifications License / Registration / Certification
Certified Pharmacy Technician (i.e. NHA/ExCPT) required.
Level of Education
HS Diploma required.
Associate's Degree strongly preferred.
Years Of Experience
2–3 years of pharmacy technician experience required.
2+ years of pharmacy or health insurance office experience strongly preferred.
Minimum Knowledge, Skills, And Abilities
Knowledge of medications, generic substitutions, office ordering practices, lab requirements, and refills.
Familiarity with Epic or other EMR/EHR systems.
Understanding of the medical insurance industry and health plans.
Proficient computer navigation skills with advanced Microsoft Office/Outlook and internet experience.
Medical Terminology knowledge.
Effective communication skills.
The compensation for this role includes a base pay range of $16.30–$24.50, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.
Seniority level
Not Applicable
Employment type
Full‑time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Duly Health and Care by 2x.
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Benefits
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to community engagement and social impact.
Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
Position Highlights
Full-Time, 40 hours/week
Location: Downers Grove
Responsibilities
Data Collection and Documentation 40%
Receives and documents telephonic and/or electronic requests for medications requiring prior authorization from Primary Care Physicians, Specialists, and Ancillary providers.
Verifies member eligibility and basic benefit coverage levels including coordination of benefits and third‑party liability.
Utilizes internal and external resources to determine provider networks.
Evaluates each Prior Authorization request to ensure all required information, codes, place of service, and provider details are available for submission.
Investigates and obtains missing medical information from providers.
Maintains accurate documentation and follows patient privacy in accordance with HIPAA and Duly policies.
Interface with Health Plans and Provider offices 40%
Contacts physician offices, pharmacies, review organizations, and insurance companies for prior approval requirements and to submit appropriate forms.
Provides ongoing education to physician offices regarding prior authorization processes and requirements.
Maintains current knowledge of all health plan carrier requirements related to prior authorizations and approval paths.
Applies clinical knowledge, health plan formularies, ICD‑10 and CPT coding, and medical terminology for communication with physicians and providers.
Serves as a resource to physician/provider offices regarding prior authorization requirements and alternative medication availability.
Provides timely notifications of approval or denial decisions through designated communication routes.
System entry and other functions 20%
Performs data entry and processing of prior authorization requests through the EPIC system and edits notes per department guidelines.
Maintains accurate prior authorization notes and patient chart documentation entries.
References Team Lead or Supervisor/Manager for review of complex requests.
Provides input to management regarding improvements to operating practices.
Assists with orientation and training of new staff.
Qualifications License / Registration / Certification
Certified Pharmacy Technician (i.e. NHA/ExCPT) required.
Level of Education
HS Diploma required.
Associate's Degree strongly preferred.
Years Of Experience
2–3 years of pharmacy technician experience required.
2+ years of pharmacy or health insurance office experience strongly preferred.
Minimum Knowledge, Skills, And Abilities
Knowledge of medications, generic substitutions, office ordering practices, lab requirements, and refills.
Familiarity with Epic or other EMR/EHR systems.
Understanding of the medical insurance industry and health plans.
Proficient computer navigation skills with advanced Microsoft Office/Outlook and internet experience.
Medical Terminology knowledge.
Effective communication skills.
The compensation for this role includes a base pay range of $16.30–$24.50, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.
Seniority level
Not Applicable
Employment type
Full‑time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Duly Health and Care by 2x.
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr