Reviews, processes, and troubleshoots prior authorization requests for medications through phone, fax, and web submissions. Researches claims, communicates authorization criteria and request status to providers, provides formulary information, follows Medicare, Medicaid, HIPAA, regulatory, and client-specific requirements, and collaborates with clinical teams to meet accuracy, compliance, and performance goals.
CompanyNavitus
About UsNavitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
Pay RangeUSD $20.00 - USD $20.00 /Hr.
STAR Bonus % (At Risk Maximum)0.00 - Ineligible
Work Schedule Description (e.g. M-F 8am to 5pm)Varies
Remote Work NotificationATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Overview
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. 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.
Is this you? Find out more below!
ResponsibilitiesHow do I make an impact on my team?
- 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 such activities eLearning classes, participation in the Navitus CPhT program, and by continually reviewing all available resources used in prior authorization processing
- Maintain scheduled hours and demonstrate flexibility to aid in hour coverage
- Other duties as assigned
What our team expects from you?
- 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
What can you expect from Navitus?
- 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!
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