Location: Arlington, TX

Schedule: 9am-5:30pm Monday through Friday

Setting: Hybrid (fully onsite during training - 3 days in office & 2 days remote upon completion of training)

Pay: $17-19/hr

Position Overview:

This role involves facilitating effective communication regarding Therapeutic Interchanges and prior authorization requests, ensuring seamless coordination across teams. The position is responsible for investigating and contacting insurance plans to resolve payment denial issues, while working closely with Physicians and Facilities to gather necessary details for resolution. Additionally, the role requires updating prior authorization requests with clinical justifications, all while adhering to guidance from a registered Pharmacist.

Key Responsibilities:

• Act as a primary contact for medical facilities, assisting with documentation requirements and following up on unresolved claims.
• Possess a strong understanding of insurance and Medicaid formularies, along with related prior authorization procedures.
• Proactively engage with Facilities, Health Plans, and Physician offices through outbound communication to secure authorization approvals.
• Collaborate with Client Billing Services, Pharmacy Directors, and other stakeholders to resolve customer concerns and issues effectively.
• Meet or exceed productivity benchmarks related to claims and calls per hour.
• Offer clinical support to team members in addressing prior authorization-related queries.
• Demonstrate familiarity with the claims adjudication process.
• Develop expertise in insurance verification, claims adjudication, and billing procedures, becoming a key resource on the insurance workflows and billing queues.
• Prioritize and manage tasks to meet deadlines and ensure smooth operations.
• Proficiently use Microsoft Office tools to manage documentation and communication.