Hybrid Authorization Lead presso CarepathRx

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

Under minimal supervision, the Authorization Lead oversees the authorization process for specialty and infusion pharmacy services, managing the review of initial and renewal prior authorization requests while ensuring compliance with formulary guidelines. This role involves collaborating with clinicians to secure necessary medical documentation, conducting quality reviews, and providing orientation, mentoring, and daily oversight of team members. Additionally, the Lead Authorization Specialist monitors team performance, creates and updates policies and procedures, and ensures the efficiency and integrity of the authorization process while supporting staff development and operational excellence. ​Expert knowledge on formulary exceptions and prior authorization requirements/time frames according to line of business and payer.

Responsibilities

• Takes the initiative to present ideas/suggestions to management.

• Utilizes appropriate communication lines in relaying problems, concerns, questions, and ideas.

• Demonstrates the ability to work effectively and maintain expected productivity.

• Cooperate with other staff members when planning and organizing daily activities.

• Always maintains a courteous demeanor.

• Prioritizes and completes work on schedule.

• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks.

• Ensure initial and renewal authorizations are requested in a timely manner.

• Interface with other departments and identify medical documentation in support of prior authorization requests.

• Demonstrates ability to communicate effectively and express ideas clearly.

• Conduct team meetings as needed/required.

• Assist supervisor in monitoring workflow to ensure accounts are worked timely and accurately.

• Collaborate with management to identify efficiencies.

• Assist the supervisor in providing feedback on staff performance.

• Assist employees with day-to-day questions, issues, or problems.

• Assist in the interview process when recruiting new hires.

• Performs in accordance with system-wide competencies/behaviors.

• Learn the CareTend system software

• Define current workflow and create a bridge to new system

• Support training of staff

• Other duties as assigned to support CareTend process development

• Performs other duties as assigned.

Skills & Abilities

• Excellent written and verbal communication

• Organized

• High Integrity

• Interpersonal skills

• Adaptability

• Time Management

• Conflict resolution

Requirements

• HS diploma or GED required.

• 1-2 years of pharmacy claims, pharmacy tech, and/or other related experience in physician practice, ancillary provider, or other relevant healthcare setting required.

• Knowledge of medical terminology, coordination of benefits

• Knowledge of payer websites preferred.

• Knowledge of medical terminology required.

• Knowledge of pharmacy payers and authorization requirements preferred Proficient computer skills and Microsoft Office Products required. Excellent customer service skills.

• Self-starter with the ability to work with minimum supervision.

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.