Prior Authorization Representative

Accredo Health Columbus , OH 43216

Posted 4 months ago

POSITION SUMMARY

Review requests from doctors and pharmacists to determine whether medication coverage prior authorization can be given by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.

ESSENTIAL FUNCTIONS

  • Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.

  • Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions.

  • Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement.

  • Work collaboratively with other associates and supervisor to ensure that best practices are shared.

  • Other special projects as assigned.

QUALIFICATIONS

  • High School Diploma or GED

  • 2 3 years relevant experience

  • Conflict resolution skills; excellent organizational skills

  • Superior written and verbal communication and presentation skills

  • Strong interpersonal skills

  • Ability to handle challenging customers in a professional manner

  • Ability to adapt in a dynamic work environment learns quickly, solve problems and make decisions

  • Willingness to work a flexible schedule for peak call times

  • Must be able to work Monday through Friday 1:30pm-10:00pm

ABOUT DEPARTMENT

The Pharmacy Operations Group is crucial to achieving our mission of helping to achieve a more sustainable health care system and better health for all. Members of this team are on the front line every day interacting with patients, strategizing on improvements and efficiencies, and processing more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country.

ABOUT EXPRESS SCRIPTS

At Express Scripts, we dare to imagine a better health care system, and we're driven to make it happen. Where some see obstacles, we see possibilities. We're challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.

We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes like no one else can. We believe health care can do more. We are Champions For BetterSM.

Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.


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Prior Authorization Representative

Accredo Health