Prior Authorization Specialist  
MED CC Pvt. Ltd.   More jobs from this company

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Job Title:   Prior Authorization Specialist
Category:   Client Services
Total Positions:   1
Job Location:   Lahore
Gender:   No Preference
Minimum Education:   Bachelors
Career Level:   Experienced Professional
Minimum Experience:   2 Years
Salary Range:   PKR 50,000 to 60,000 per Month
Apply By:   Aug 19, 2021
Job Description:
  • Apply clinical knowledge when assessing and responding with alternatives to denied pharmacy prior authorizations
  • Collaborate with other departments to assist in obtaining prior authorizations
  • Conduct denial reviews to provide recommendations for providers and support appeals submission if requested
  • Document all prior authorization information including approval dates and authorization numbers within the patients record
  • Facilitate medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
  • Follow prior authorization work flow and policies and procedures
  • Follow-up on all pending prior authorizations within 48 hours
  • Identify insurance treatment requirements and review the patient medical record to assure the requirements are met for prior authorization approval
  • Manage correspondence with insurance companies, physicians, pharmacies and patients as required
  • Obtain approval/denial letters
  • Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes
  • Research and document coverage determination requests for prior authorization by independently researching the EMR chart notes and historical clinical data to identify prior therapies and treatments
  • Review accuracy and completeness of information requested for prior authorizations and ensure all is appropriate and closely monitored
  • Respond to urgent requests or emails submitted by the Provider in a timely manner

Company Information
Company Name:  MED CC Pvt. Ltd.
Company Description:
Pharmaceutical company

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