Here at CiNQ Recruitment, we believe in finding the right fit, for you and our clients. Whether you seek long-term employment solutions for your business or your next career move, we understand the importance of individual and business needs. With over 30 years of successful staffing and recruiting experience, we excel at providing passive candidates with the right skills and cultural fit for specialized positions. Here is the opportunity to work with an exciting pharmaceutical company.

We are seeking a Prior Authorization Specialist to join our team! The Prior Authorization specialist will perform insurance verification, benefit eligibility, and prior authorizations for specialty medications.

Prior Authorization Specialist Requirements:

• Previously Specialty Pharmacy Experience HIGHLY PREFERRED*
• 2-3 years benefits investigation experience
• 2-3 years prior authorization experience
• Excellent customer service skills with the ability to build effective, appropriate and enduring customer and provider relationships.
• Valid CA Pharmacy Technician License 
• High School Diploma Required

Prior Authorization Specialist Job Duties:

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
• Investigate and verify benefits for pharmacy and medical third-party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
• Obtain prior authorizations; initiate requests, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization.
• Facilitate appeals process between the patient, physician and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician.
• Composes clinical appeals letters based off of specific denial reason and patient’s clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative document with patient and physician office.
• Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial status. Obtains approval information and activates copay cards based off of eligibility and specific drug prescribed.
• Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy.
• Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received. Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription. Confirm with patient that prescription was received from alternate specialty pharmacy.

Job Type: Full-time

Salary: $17.00 to $22.00 /hour

All your information will be kept confidential according to EEO guidelines.