Emergent Holdings
Overview
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Prior Authorization Specialist
role at
Emergent Holdings . Support BCBSM and BCNA providers (pharmacists and physicians) with Medicare drug coverage inquiries, grievances, and prior authorizations. Responsibilities/Tasks
Answer telephones in an efficient and timely manner to lend appropriate assistance to providers Process prior authorization requests under the supervision of a Clinical Pharmacist Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests Analyze written, faxed, and verbal inquiries which leads to entry of pharmacy authorizations into the system Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool Troubleshoot problems, inquiries, and new processing procedures for coverage determinations Perform other related duties as assigned Qualifications
Education or Equivalent Experience
High School Graduate or GED equivalent required. Two (2) years of college preferred. Experience
Two (2) years experience in retail or hospital Pharmacy required Pharmacy Technician Certification (PTCB) preferred Knowledge of prescription drug names, therapeutic classes and claims processing Experience with Medicare Part B prescription benefits may be preferred for some positions Skills/Knowledge/Abilities (SKA) Required
Knowledge of pharmacy claims processing Understanding of formularies and utilization management edits Familiarity with Medicare Guidelines and Timeframes Computer literate (Microsoft Office products) Ability to read and comprehend simple instructions, short correspondence, and memos; write simple correspondence; effectively present information in one-on-one and small group settings Ability to perform basic arithmetic operations and interpret data (rate, ratio, percent, bar graphs) Working Conditions
Work is performed in an office setting with no unusual hazards. The qualifications listed above represent the minimum levels to perform the duties and responsibilities of the position. Job Details
Employment type: Full-time Seniority level: Entry level Industry: Insurance Job function: Other Compensation and Legal
PAY RANGE: Actual compensation decision relies on internal equity, candidate skills and experience, geographic location, market, and other factors. Estimated range: $45,800 to $76,600. EEO Statement: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or disability. Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.
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Join to apply for the
Prior Authorization Specialist
role at
Emergent Holdings . Support BCBSM and BCNA providers (pharmacists and physicians) with Medicare drug coverage inquiries, grievances, and prior authorizations. Responsibilities/Tasks
Answer telephones in an efficient and timely manner to lend appropriate assistance to providers Process prior authorization requests under the supervision of a Clinical Pharmacist Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests Analyze written, faxed, and verbal inquiries which leads to entry of pharmacy authorizations into the system Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool Troubleshoot problems, inquiries, and new processing procedures for coverage determinations Perform other related duties as assigned Qualifications
Education or Equivalent Experience
High School Graduate or GED equivalent required. Two (2) years of college preferred. Experience
Two (2) years experience in retail or hospital Pharmacy required Pharmacy Technician Certification (PTCB) preferred Knowledge of prescription drug names, therapeutic classes and claims processing Experience with Medicare Part B prescription benefits may be preferred for some positions Skills/Knowledge/Abilities (SKA) Required
Knowledge of pharmacy claims processing Understanding of formularies and utilization management edits Familiarity with Medicare Guidelines and Timeframes Computer literate (Microsoft Office products) Ability to read and comprehend simple instructions, short correspondence, and memos; write simple correspondence; effectively present information in one-on-one and small group settings Ability to perform basic arithmetic operations and interpret data (rate, ratio, percent, bar graphs) Working Conditions
Work is performed in an office setting with no unusual hazards. The qualifications listed above represent the minimum levels to perform the duties and responsibilities of the position. Job Details
Employment type: Full-time Seniority level: Entry level Industry: Insurance Job function: Other Compensation and Legal
PAY RANGE: Actual compensation decision relies on internal equity, candidate skills and experience, geographic location, market, and other factors. Estimated range: $45,800 to $76,600. EEO Statement: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or disability. Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.
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