Specialist I, Prior Authorization

The Specialist I, Prior Authorization (PAS) will review, process, and troubleshoot incoming Prior Authorization requests for various medications. The Specialist I, Prior Authorization (PAS) will accurately process the requests according to regulatory and client specific guidelines. The PAS will work with other team members to meet the departmental performance metrics and maintain compliance. The PAS will work with clinical to ensure requests are processed accurately and timely. The PAS will process requests that come in via phone, fax, and web submission. Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit Communicate prior authorization criteria to providers Act as a provider help desk specialist to aid providers in submitting prior authorization requests, providing formulary product information, and communicating prior authorization request status Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs. Maintain scheduled hours and demonstrate flexibility to aid in hour coverage Other duties as assigned