专员 I，预先授权
Specialist I, Prior Authorization
公司
Navitus公司简介
Navitus - 以患者为中心的药房 - Navitus 是传统药房福利管理（PBM）模式的一种替代方案。我们致力于从药品供应链中去除成本，使需要药物的人们能够负担得起。在 Navitus，我们的团队成员在一个庆祝多样性、激发创造力并鼓励成长的环境中工作。我们欢迎新想法，并对为客户提供优质服务以及彼此之间充满热情。现任员工必须使用 SSO 登录选项才能考虑内部机会。我们致力于为所有申请人和员工提供平等的就业机会，并遵守所有适用的反歧视法规，包括与受保护退伍军人和残疾人士相关的规定。所有合格的申请人都将根据种族、肤色、宗教、性别、国籍或残疾情况获得就业考虑。
薪资范围
美元 20.00 - 美元 20.00 /小时
STAR 奖金百分比（风险最大值）
0.00 - 不符合资格
工作时间描述（例如：周一至周五 上午8点至下午5点）
视情况而定
远程工作通知
注意：Navitus 无法为阿拉斯加、夏威夷、缅因州、密西西比州、新罕布什尔州、新墨西哥州、北达科他州、罗德岛州、南卡罗来纳州、南达科他州、西弗吉尼亚州和怀俄明州的居民提供远程工作。
简介
Navitus Health Solutions 正在寻找一名初级专家，负责事先授权！
初级专家，事先授权（PAS）将审查、处理和解决各种药物的事先授权请求。初级专家，事先授权（PAS）将根据监管和客户特定指南准确处理这些请求。PAS 将与其他团队成员合作，以满足部门绩效指标并保持合规性。PAS 将与临床团队合作，确保请求得到准确和及时的处理。PAS 将处理通过电话、传真和网络提交的请求。
这就是你吗？下面了解更多！
职责
我如何对我的团队产生影响？
- 研究和分析电子和手动索赔。运用故障排除技能，根据个人福利允许的情况解决问题
- 向提供者传达事先授权标准
- 担任提供者帮助台专家，协助提供者提交事先授权请求，提供处方集产品信息，并传达事先授权请求的状态
- 处理来自电话、传真和网络提交的请求
查看英文原文
Company
NavitusAbout Us
Navitus - 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 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 Range
USD $20.00 - USD $20.00 /Hr.STAR Bonus % (At Risk Maximum)
0.00 - IneligibleWork Schedule Description (e.g. M-F 8am to 5pm)
VariesRemote Work Notification
ATTENTION: 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!
Responsibilities
How 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
Qualifications
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!
Location : Address
RemoteLocation : Country
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