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Prior Authorization Specialist FRx


Franklin, Tennessee

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Job ID 21000GIH

Available Openings 3

PURPOSE AND SCOPE:

Reviews, verifies, and processes prior authorizations in the pharmacy management system’s work queue. Serves as a resource to patients, dialysis facility personnel, and other Fresenius Medical Care employees for prior authorizations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Under general supervision, follows established company policies and procedures and applies acquired job skills to verify insurance rejections and contact clinics to initiate and receive information to complete prior authorizations for patients.
  • Assists clinics and patients with understanding prior authorizations and their pharmacy benefits.
  • Educates patients regarding requirement for insurance plan to complete prior authorization.
  • Answers inbound inquires related to prior authorizations and insurance claims.
  • Completes outbound calls to payors and clinics to assist with prior authorizations.
  • Verifies insurance coverage by phone, online or through E1 (electronic system) transactions for all new patients and/or changes in coverage.
  • Enters patient insurance information under the patient’s account in the pharmacy data system.
  • Ability to review multiple pharmacy management platforms simultaneously to complete daily tasks.
  • Demonstrates knowledge and understanding of insurance billing and prior authorization requirements demonstrating analytical thinking.
  • Monitors all patients’ prior authorizations to ensure that it is initiated and progressing through the pharmacy management system.
  • Performs functions that require full knowledge of general aspects of the job.
  • Works on assignments that are semi-routine in nature, but recognizes the need for occasional deviation from accepted practice.
  • Escalates issues to supervisor or appropriate department for resolution, as deemed necessary.
  • Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
  • Assists with various projects as assigned by direct supervisor.
  • Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.


PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


SUPERVISION:

  • None


EDUCATION:

  • High School Diploma required


EXPERIENCE AND REQUIRED SKILLS:

  • 1 – 2 years’ related experience


EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity


Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.