About our company:

Ivira Health is a leading healthcare organization dedicated to improving patient outcomes and providing quality healthcare services. We are seeking a skilled and experienced Prior Authorization Specialist to join our team and contribute to our mission of ensuring seamless medication access for our patients.

Job Summary:

As a Prior Authorization Specialist for Medication Claims, you will play a vital role in our organization by facilitating the approval process for medications billed to Pharmacy Benefit Managers (PBMs) and health insurance plans. You will be responsible for ensuring that patients receive the medications they need in a timely and efficient manner.

General Duties and Responsibilities

• Review and evaluate medication prior authorization requests.
• Gather and compile all necessary documentation and information for submission.
• Communicate with healthcare providers, insurance companies, and PBMs to obtain authorization.
• Monitor the status of authorization requests and follow up as needed.
• Ensure compliance with insurance guidelines and regulations.
• Maintain accurate records and documentation related to prior authorization requests.
• Provide excellent customer service to patients, healthcare providers, and insurance representatives.
• Collaborate with the pharmacy team to optimize medication access for patients.

Required Qualifications and Experience

• Bachelor's degree in healthcare administration, pharmacy, or related field (preferred).
• Proven experience in the prior authorization process for medications, preferably within a healthcare setting.
• Knowledge of pharmacy benefit management (PBM) and health insurance plans.
• Strong understanding of medical terminology and pharmacy practices.
• Excellent communication and interpersonal skills.
• Detail-oriented and organized with a strong ability to multitask.
• Proficient in using computer software and electronic health records (EHR) systems.

Benefits:

• Competitive salary and benefits package.
• Opportunity for professional growth and development.
• A supportive and collaborative work environment.
• Making a meaningful impact on patient care and well-being.

Work Environment

This job operates primarily in an office environment. This position requires the use of standard office equipment, and frequent standing and walking.

Disclaimer

The above job description is intended to describe the general nature and level of work being performed by employees assigned to this job. It is not designed to capture or illustrate a comprehensive list of all responsibilities, duties, and skills required of employees assigned to this job.

Job Types: Full-time, Part-time

Weekly day range:

• Monday to Friday

Work Location: Hybrid remote in Wilmington, DE 19805