Prior Authorization Specialist

• Manage and identify a portfolio of rejected pharmacy claims
• Research, analyze, and resolve rejected claims with Medicare Part D plans, third-party insurance companies, and state Medicaid plans
• Perform edits and reversals to secure claim approvals and maximize payer reimbursement
• Contact providers and facility contacts to obtain additional information
• Monitor and resolve revenue at risk related to payer setup, billing, rebilling, and reversal processes
• Identify, document, communicate, and resolve payer and billing trends and issues as part of a team
• Complete, communicate, and submit prior authorization forms promptly
• Support training needs
• Prepare and maintain processing reports and records
• Follow applicable government regulations, including HIPAA
• Comply with departmental safety, attendance, and dress-code policies
• Conduct responsibilities according to the company Code of Business Conduct and Ethics, policies, Corporate Compliance Agreement, federal and state laws, and professional standards
• Perform other assigned duties as business needs require

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