Prior Authorization Specialist

Salary Range for Prior Authorization Specialist in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

The salary range for a Prior Authorization Specialist in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds typically falls between $40,000 and $70,000 per year.

Sample Job Description for Prior Authorization Specialist in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds Industry

Job Description:

As A Prior Authorization Specialist In Pharmacy Benefit Management And Other Third Party Administration Of Insurance And Pension Funds, Your Primary Objective Is To Ensure The Accurate And Timely Processing Of Prior Authorization Requests For Medications Or Medical Services. You Will Be Responsible For Reviewing Requests, Verifying Eligibility, And Determining Coverage Based On Established Criteria And Guidelines.

Job Requirements:

1. Bachelor'S Degree In Healthcare Administration, Pharmacy, Or A Related Field (Or Equivalent Experience). 2. Strong Knowledge Of Medical Terminology, Coding Systems, And Insurance Regulations. 3. Familiarity With Pharmacy Benefit Management Practices And Prior Authorization Processes. 4. Excellent Analytical And Problem-Solving Skills. 5. Detail-Oriented With The Ability To Prioritize And Manage Multiple Tasks. 6. Proficient Computer Skills, Including Experience With Pharmacy Software And Electronic Medical Records. 7. Effective Communication And Interpersonal Skills To Collaborate With Healthcare Providers, Insurance Companies, And Patients. 8. Ability To Maintain Confidentiality And Adhere To Hipaa Regulations. 9. Strong Organizational Skills And The Ability To Work In A Fast-Paced Environment. 10. Knowledge Of Medicare And Medicaid Guidelines (Preferred).

Job Responsibilities:

1. Review And Evaluate Prior Authorization Requests For Medications And Medical Services. 2. Verify Patient Eligibility And Coverage For Requested Treatments. 3. Determine If Prior Authorization Is Required And Ensure All Necessary Documentation Is Provided. 4. Follow Established Guidelines And Criteria To Approve Or Deny Prior Authorization Requests. 5. Communicate With Healthcare Providers To Gather Additional Information Or Clarification. 6. Coordinate With Insurance Companies To Obtain Necessary Authorizations And Ensure Accurate Billing. 7. Maintain Accurate Records Of Prior Authorization Requests And Outcomes. 8. Monitor And Track Prior Authorization Trends And Identify Areas For Improvement. 9. Provide Support And Guidance To Healthcare Providers And Patients Regarding Prior Authorization Processes. 10. Stay Updated On Industry Changes And Regulations Related To Prior Authorization.

Top 10 Employers for Prior Authorization Specialist in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. Express Scripts - Headquarters: St. Louis, Missouri, USA - Website: www.express-scripts.com 2. CVS Health - Headquarters: Woonsocket, Rhode Island, USA - Website: www.cvshealth.com 3. OptumRx - Headquarters: Eden Prairie, Minnesota, USA - Website: www.optumrx.com 4. Cigna - Headquarters: Bloomfield, Connecticut, USA - Website: www.cigna.com 5. Aetna - Headquarters: Hartford, Connecticut, USA - Website: www.aetna.com 6. Humana - Headquarters: Louisville, Kentucky, USA - Website: www.humana.com 7. Anthem, Inc. - Headquarters: Indianapolis, Indiana, USA - Website: www.anthem.com 8. UnitedHealth Group - Headquarters: Minnetonka, Minnesota, USA - Website: www.unitedhealthgroup.com 9. Magellan Health - Headquarters: Scottsdale, Arizona, USA - Website: www.magellanhealth.com 10. Prime Therapeutics - Headquarters: Eagan, Minnesota, USA - Website: www.primetherapeutics.com

Career Path for Prior Authorization Specialist in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. High school diploma or equivalent 2. Pharmacy Technician Certification (optional) 3. Pharmacy Technician 4. Prior Authorization Technician 5. Prior Authorization Specialist - Recommended years in each position: - Pharmacy Technician: 2-3 years - Prior Authorization Technician: 2-3 years - Prior Authorization Specialist: 3-5 years

Top 5 Countries by Prior Authorization Specialist in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. United States 2. Canada 3. United Kingdom 4. Australia 5. Germany

Top 5 Countries with Established Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. United States 2. Canada 3. United Kingdom 4. Australia 5. Germany