Pharmacy Prior Authorization Specialist

Job Address: 9299 Market Place Broadview Heights, OH 44147 Job Description: Prior Authorization Specialist Reports to: Pharmacy Prior Authorization Manager Job Type: Full-Time – Remote – Pharmacies: West Virginia, Ohio, Indiana and Maryland Position Overview: The Prior Authorization Specialist will maintain the Prior Authorization’s workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process. Key Responsibilities Include but are not limited to: Work in cohesion with the Adjudication, Claim Intervention and Billing Departments Submit prior authorizations in accordance with Insurance regulations Ensure accurate and timely processing of prior authorizations Work directly with insurance companies for prior authorization resolution Communicate with facilities to gain additional information Any other duties assigned Follow federal and state regulations Adhere to company policies and procedures Follow HIPPA guidelines and regulations Qualifications and Requirements: Prior Authorization experience (not required) Previous Long-Term Care pharmacy experience a plus (not required) Knowledge of Framework LTC a plus (not required) Salary and Benefits: Competitive salary commensurate with experience Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.