Prior Authorization

Job DetailsJob LocationPolaris Pharmacy Services of Los Angeles - Covina, CAPosition TypeFull TimeJob CategoryPharmaceuticalDescriptionPRIOR AUTHORIZATION SPECIALISTWHO WE ARE Polaris Pharmacy Services is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members. Currently we are recruiting for experienced Prior Authorization Technicians to join the Polaris team.OVERVIEWThe 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.RESPONSIBILITIESManage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customersResearch, 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 deadlinesEnsure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursementContact providers and/or customers as necessary to obtain additional informationMonitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processesWork as a team to identify, document, communicate, and resolve payer/billing trends and issuesComplete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely mannerReview and work convert billing exception reports to ensure claims are billed to accurate financial plansComplete billing transactions for non-standard order entry situations as requiredSupport training needsPrepare and maintain reports and records for processingPerform other tasks as assigned.Follow all applicable government regulations, including HIPAAComply with departmental policies regarding safety, attendance, and dress codeOvertime, holidays, and weekends may be required and/or expectedConduct 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 standardsOther duties as assigned; Job duties may vary depending on business needsQualificationsQUALIFICATIONSHigh School diploma or equivalent requiredMinimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred)Framework LTC & General computer knowledge & 10-key Number Entry preferred Able to read, write, speak, and understand the English languageAble to retain a large amount of information and apply that knowledge to related situations Able to work in a fast-paced environmentBasic computer knowledge skills requiredBasic math and analytical skillsExperience with alpha-numeric data entryProficient in Microsoft Word, Excel, and Outlook requiredCustomer ServiceResults-orientedGood organization/Attention to detailReliable Problem solverAble to work various shifts and daysAdaptability to an ever-changing environmentPHYSICAL DEMANDSThe 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 dayThe employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittentlyMay be necessary to work extended hours as neededMay lift and/or move up to 50 poundsThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this roleHOLIDAY & PTO POLICYPaid holidays are provided annually, with 6 days offered each year, along with 5 sick days.Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.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 employeesMedical, Dental, and Vision insurance401 (k) (available for Part Time & Full Time EEs)Company Paid Life insurance Short-term and Long-term disability insuranceTuition reimbursementPersonal Time Off (PTO)Competitive pay with annual performance reviews and merit-based raisesCareer growth potentialAnnual on-site voluntary Flu VaccineEmployee referral bonus program Apply tot his job