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Prior Authorization Representative
Ref No.: 18-08258
Location: New York, New York
Start Date / End Date: 07/23/2018 to 12/30/2018
Job Title: Prior Authorization Representative/Exceptions Coordinator (631429)
Location: New York NY 10006
Duration: 6 Months


Job summary:
  • Responsible for all authorizations being processed in the expected timeframe. Identifies all outliers/exceptions, and provides feedback to appropriate departments, ensuring prescriptions are not delayed.
  • Monitors the medical management system for any work in queue. Coordinates information for outreach of new or changed services for all departments.

Essential functions:
  • Monitors the medical management system Case Trakker alert and service request queues and processes authorizations. Monitors the failed fax, and resends faxes to ensure receipt
  • Coordinates information about outreach for new prescriptions with appropriate staff and departments who receive the faxes.
  • Generates letters through the system as needed. Utilizes both fax and phone notification to contact physician`s office for the above activities.
  • Log into ACD line to respond to requests from LHCSA regarding authorization status.
  • Make outreach calls to members as needed

Requirements/Certifications:
  • HS/GED Requirements
  • 1-2 year's experience with a LHCSA or health plan experience
  • Must have a professional presence and strong written and verbal communication skills. Must be a team player. Requires intermediate knowledge of Excel and medical management system.