Polaris Pharmacy Services
Prior Authorization Supervisor
Polaris Pharmacy Services, Covina, California, United States, 91722
Prior Authorization Supervisor
– Polaris Pharmacy Services
Who We Are Polaris Pharmacy Services is a dedicated partner in care, transforming how patients experience long‑term, post‑acute, correctional, PACE, and specialty pharmacy services. Founded in 2015, Polaris is locally and independently owned with a growing national footprint. We provide competitive pay, comprehensive benefits, and genuine opportunities for career advancement.
Job Summary The Prior Authorization Supervisor manages a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing, eliminating financial risks to Polaris and its customers. The role requires responsive customer interaction and leadership of the prior authorization team to maintain efficient workflow.
Duties/Responsibilities
Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
Research, analyze, and resolve rejected claims by working with national Medicare D plans, third‑party insurance companies, and state Medicaid plans to meet critical deadlines.
Perform appropriate edits or reversals to secure payer reimbursement.
Contact providers and facility contacts to obtain additional information as needed.
Monitor and resolve revenue at risk associated with payer set‑up, billing, rebilling, and reversal processes.
Collaborate with the team to identify, document, communicate, and resolve payer/billing trends and issues.
Complete, communicate, and submit prior authorization forms in a timely manner.
Support training needs.
Prepare and maintain reports and records for processing.
Follow all applicable government regulations, including HIPAA.
Comply with departmental policies regarding safety, attendance, and dress code.
Work overtime, holidays, and weekends as required.
Adhere to company policies, the Code of Business Conduct and Ethics, and applicable federal and state laws.
Perform other tasks as assigned.
Qualifications / Competencies
Proficient in English; strong written and verbal communication.
Excellent memory and ability to apply knowledge to related situations.
Ability to work in a fast‑paced environment.
Basic computer skills, including Microsoft Word, Excel, and Outlook.
Basic math and analytical skills; alpha‑numeric data entry.
Customer‑service orientation; results‑oriented and detail‑focused.
Reliable, problem‑solving, adaptable.
Flexible to work various shifts and days.
Education and Experience
High School diploma or equivalent (required).
Minimum one (1) year as a pharmacy technician in a retail environment preferred (long‑term care pharmacy preferred).
Basic LTC & general computer knowledge & 10‑key number entry preferred.
Physical Demands
May sit or stand 7–10 hours per day.
May need to sit, climb, balance, stoop, kneel, bend, or walk.
May require extended hours.
May lift or move up to 30 pounds.
Holiday & PTO Policy
Paid holidays: 6 days per year; 5 sick days.
Employees earn up to 10 PTO days per year with rollover options and milestone bonuses.
Option to cash out up to 10 PTO hours per quarter.
Benefits for Full‑Time Employees
Medical, Dental, and Vision insurance.
401(k) (available for both part‑time & full‑time employees).
Company‑paid life insurance.
Short‑term and long‑term disability insurance.
Tuition reimbursement.
Personal Time Off (PTO).
Competitive pay with annual performance reviews and merit‑based raises.
Career growth potential.
Annual on‑site voluntary flu vaccines.
Employee referral bonus program.
Additional Details
Seniority Level:
Mid‑Senior level
Employment type:
Other
Job function:
Other
Industries:
Pharmaceutical Manufacturing
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– Polaris Pharmacy Services
Who We Are Polaris Pharmacy Services is a dedicated partner in care, transforming how patients experience long‑term, post‑acute, correctional, PACE, and specialty pharmacy services. Founded in 2015, Polaris is locally and independently owned with a growing national footprint. We provide competitive pay, comprehensive benefits, and genuine opportunities for career advancement.
Job Summary The Prior Authorization Supervisor manages a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing, eliminating financial risks to Polaris and its customers. The role requires responsive customer interaction and leadership of the prior authorization team to maintain efficient workflow.
Duties/Responsibilities
Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
Research, analyze, and resolve rejected claims by working with national Medicare D plans, third‑party insurance companies, and state Medicaid plans to meet critical deadlines.
Perform appropriate edits or reversals to secure payer reimbursement.
Contact providers and facility contacts to obtain additional information as needed.
Monitor and resolve revenue at risk associated with payer set‑up, billing, rebilling, and reversal processes.
Collaborate with the team to identify, document, communicate, and resolve payer/billing trends and issues.
Complete, communicate, and submit prior authorization forms in a timely manner.
Support training needs.
Prepare and maintain reports and records for processing.
Follow all applicable government regulations, including HIPAA.
Comply with departmental policies regarding safety, attendance, and dress code.
Work overtime, holidays, and weekends as required.
Adhere to company policies, the Code of Business Conduct and Ethics, and applicable federal and state laws.
Perform other tasks as assigned.
Qualifications / Competencies
Proficient in English; strong written and verbal communication.
Excellent memory and ability to apply knowledge to related situations.
Ability to work in a fast‑paced environment.
Basic computer skills, including Microsoft Word, Excel, and Outlook.
Basic math and analytical skills; alpha‑numeric data entry.
Customer‑service orientation; results‑oriented and detail‑focused.
Reliable, problem‑solving, adaptable.
Flexible to work various shifts and days.
Education and Experience
High School diploma or equivalent (required).
Minimum one (1) year as a pharmacy technician in a retail environment preferred (long‑term care pharmacy preferred).
Basic LTC & general computer knowledge & 10‑key number entry preferred.
Physical Demands
May sit or stand 7–10 hours per day.
May need to sit, climb, balance, stoop, kneel, bend, or walk.
May require extended hours.
May lift or move up to 30 pounds.
Holiday & PTO Policy
Paid holidays: 6 days per year; 5 sick days.
Employees earn up to 10 PTO days per year with rollover options and milestone bonuses.
Option to cash out up to 10 PTO hours per quarter.
Benefits for Full‑Time Employees
Medical, Dental, and Vision insurance.
401(k) (available for both part‑time & full‑time employees).
Company‑paid life insurance.
Short‑term and long‑term disability insurance.
Tuition reimbursement.
Personal Time Off (PTO).
Competitive pay with annual performance reviews and merit‑based raises.
Career growth potential.
Annual on‑site voluntary flu vaccines.
Employee referral bonus program.
Additional Details
Seniority Level:
Mid‑Senior level
Employment type:
Other
Job function:
Other
Industries:
Pharmaceutical Manufacturing
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