[Hiring] Senior Prior Authorization Specialist @Pyramid Consulting

Role Description

Immediate need for a talented Senior Prior Authorization Specialist. This is a 06+ Months Contract opportunity with long-term potential and is located in US (Remote).

Key Responsibilities:

• On queue by 8am, strictly an inbound call position.
• Provide prior authorization status, how to submit prior authorization, information gathering, working with pharmacists for call backs with members.
• Process a variety of requests, inquiries, and transactions via phone, email, fax, and mail.
• Review requests to ensure accuracy.
• Support internal and external customers via phone or email.
• Document all pertinent information related to calls/inquiries and route unresolved issues to the appropriate area for follow-up.
• Gather and analyze data to provide feedback to Team Leads on employee development needs.
• Screen inquiries to determine if authorization is required.
• Verify member benefits and eligibility and/or provider setup.
• Maintain and update Service Requests and research incorrect or missing information.
• Triage and assign all incoming inquiries in a timely and efficient manner.
• Perform Peer Audits monthly as required.
• Provide clinical review outcome notifications to members and providers (verbal and written).

Qualifications

• Pharmacy experience, Prior authorization experience.
• 3+ years of experience in a related field.
• High school diploma or GED.
• Success within the first 30-90 days would be gaining a strong understanding of the team, processes, and performance expectations while building positive relationships with colleagues and stakeholders.

Benefits

• Pay Range: $18 - $19/hour.
• Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Company Description

Our client is a leading health insurance and healthcare Industry and we are currently interviewing to fill this and other similar contract positions.