Prior Authorization Specialist - Hybrid (Elk Grove Village, IL)
About the position Responsibilities • Contact plans (PBM or Major Medical) to validate request sent from BV • Contact physician's office to obtain current prescriptions • Contact physician's office to obtain clinical documentation that is required by the plans • Validate that the clinical documentation received is what is required by the plan • Initiate prior authorizations through Cover My Meds • Follow up on all pending PA's within 48 hours • Respond to urgent emails submitted by the Patient Care Coordinator Team or Program Manager in a timely manner • Obtain approval / denial letters • Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process • Initiate re-authorizations that are set to expire 30 days prior to the term date Requirements • Experience with Major Medical Insurance • Knowledge of Pharmacy Benefit • Knowledge of HCPC Codes (J-Codes) • Knowledge of ICD-10 Codes (Diagnoses Codes) • Familiar with medical documentation such as H&P's, Genetic testing, etc. • Ability to read prescriptions • Ability to convert a prescription into an authorization request based on payer requirements • Ability to interpret medical policies Benefits • BCBSL Medical • Delta Dental • EyeMed Vision • 401k • Accident & Critical Illness • Life Insurance • PTO, Holiday Pay, and Floating Holidays • Tuition Reimbursement Apply tot his job Apply To this Job