[Hiring] Specialist I, Prior Authorization @Navitus Health Solutions, LLC

Role Description

Navitus Health Solutions is seeking a Specialist I, Prior Authorization to join our team!

The Specialist I, Prior Authorization (PAS) will:

• Review, process, and troubleshoot incoming Prior Authorization requests for various medications.
• Accurately process requests according to regulatory and client-specific guidelines.
• Work with other team members to meet departmental performance metrics and maintain compliance.
• Collaborate with clinical teams to ensure requests are processed accurately and timely.
• Process requests that come in via phone, fax, and web submission.

Responsibilities

• 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.
• Participate in ad hoc or regularly scheduled Prior Authorization projects or projects for other Navitus departments.
• Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements.
• Utilize work down time for personal and professional development through activities such as eLearning classes, participation in the Navitus CPhT program, and continual review of available resources used in prior authorization processing.
• Maintain scheduled hours and demonstrate flexibility to aid in hour coverage.
• Other duties as assigned.

Qualifications

• A high school degree or equivalent; post high school education desired such as L.P.N., Certified Pharmacy Technician, Medical Terminology, or Medical Transcriptionist.
• Previous customer service experience required.
• Previous data entry experience preferred.
• Experience in health insurance/pharmacy insurance or managed care organization preferred.
• Prior authorization processing experience desired.
• Experience in a PBM or managed care call center desired.
• Experience in a mail or retail pharmacy setting desired.
• Experience with Medicare and/or Medicaid regulatory guidance desired.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K company match of up to 5% - No vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program – up to $750!