Prior Authorization Representative | Pharmacy Account

Job Brief:

We are looking for staff augmentation services within the Retail Pharmacy Prior Authorization (RPPA) Team and the clinic liaison teams. The goal of this initiative is to support the onshore RPPA team and liaison teams in the submission of electronic prior authorizations. This team handles an average volume of 700 pharmacy benefit electronic prior authorizations request per day. The team adheres to a service level agreement, ensuring submissions are completed within 30 minutes of receiving the request.

Key Responsibilities:

• Working within Epic and Surescripts ePA to process prior authorizations.
• Working in Epic and CoverMyMeds as needed to process prior authorizations.
• Communicating denials to clinic staff within Epic Telephone Encounter.
• Maintaining quality standards and turnaround times.
• Follow up on e-PA's due to denials or missing information.
• Calls to payor as required (or) use payor portals as required.

Required Skills:

• Experience working in Epic

Required Education and Experience

• 2-3 years retail pharmacy
• Retail Pharmacy electronic prior auth experience