Prior Authorization Analyst Sr (Remote)

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Prior Authorization Analyst Sr (Remote)

Job Description

The Senior Prior Authorization Analyst is responsible for providing advanced subject matter expertise for complex problem solving related to pharmacy claims processing where prior authorizations related to clinical programs and prior authorization operational decisions are involved.

Responsibilities

• Functional subject matter expert for prior authorization input, maintenance and issue resolution in the pharmacy claim adjudication system
• Collaborate with internal partners to create a clear understanding of request intent, desired prior authorization outcome, and implementation process expectations, including timeframe and data requirements
• Ensure quality maintenance and implementation of prior authorization loads, whether processed individually or in bulk, by completing thorough analysis of the implementation requirements, validating planned approach, completing accurate entry of prior authorizations and executing peer review or other quality assessments
• Responsible for the resolution of more complex assignments received by the team
• Responsible for the development, testing and deployment of macros to support the work of the Prior Authorization processes
• Identify new efficiencies and enhance current processes as needed
• May assist with mentoring and training Analyst level colleagues
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Business Administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required
• 5 years of benefits, claims, or PBM operations experience
• Must be eligible to work in the United States without need for a work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications

• Previous experience with Medicare or Medicaid
• Previous project management experience
• Knowledge of drugs and drug categorization
• Intermediate level Microsoft database and skills
• Excellent verbal and written communication skills
• Capable of handling multiple projects, managing work priority, setting and meeting deadlines
• Ability to work in a collaborative, team-based environment
• Strong analytical and problem-solving skills with attention to detail
• Ability to analyze and solve complex problems using analytical tools (e.g. Microsoft Excel, Microsoft Access, SAS/query tools)
• High Proficiency in RxClaims analysis, including benefits, pricing, eligibility, network and plan set-up

Preferred Qualifications

• Experience working on cross-functional projects
• Experience performing data analysis and validation
• Strong desire to be a subject matter expert
• High Proficiency in RxClaim, Lotus Notes (CRT), Microsoft Office Products (Word, Excel, Outlook), Clinical Review Engine (CRE)

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays. Apply To this Job