Prior Authorization Specialist
Prior Authorization Specialist
Prior Authorization Specialist
Phil
PHIL is a San Francisco-based health-tech startup focused on improving access to specialty pharmaceuticals. They are seeking a full-time Prior Authorization Specialist to support pharmacy operations, ensuring timely medication access for patients. The role involves verifying insurance coverage, submitting prior authorizations, and assisting healthcare providers with appeals processing.
Qualification
- Proven team player with the ability to solve problems independently
- Exceptional written and verbal communication skills
- Ability to adapt to new system and workflow changes
- Experience working in prior authorizations, medical insurance billing, and/or health insurance
- Working knowledge of ICD-10 codes and prescription drug names (preferred)
- Ability to navigate multiple systems throughout the workday
- Demonstrates flexibility to perform duties as needed based on volume
- Customer service experience (preferred)
Responsibility
- Verifies patient insurance coverage utilizing phone or online resources
- Submits prior authorizations to insurance plans in a timely manner via electronic portal
- Troubleshoots prior authorization submissions and prescription processing with health care providers
- Verbally assists providers in navigating appeals processing
- Ensures all pertinent medical documentation is accurate and present prior to authorization submission
- Compiles trends in authorization determinations for client and prescriber education
- Documents activities appropriately in process notes using the operating system
- Works closely with the Customer Support team to ensure patient success
