Pharmacy Prior Authorization Coord in Louisville, KY at ResCare

Date Posted: 11/13/2018

Job Snapshot

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Job Description


Title: Pharmacy Prior Authorization Coord

Job Category: Corporate Services

Line of Business: Pharmacy Services

About Pharmacy Services

SpringHealth Behavioral Health and Integrated Care offers a holistic approach and integrates care for people with cognitive, developmental or intellectual disabilities, who often need additional resources. SpringHealth provides behavioral analysts, therapists, social workers, counselors and psychologists who offer quality care through a multidisciplinary approach for children and adults. 

SpringHealth delivers individualized treatment based on person-centered principles. This includes assessment, consultation, supervision and support. Our clinicians take time to really learn about each person with whom they are working. They work to understand what is important to the individual, including their strengths, abilities and choices. Our clinicians think outside the box and aim to develop programs and interventions that can be generalized and used across multiple settings and with a variety of people.

As a(n) Pharmacy Prior Authorization Coord you will: 

The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question. 

Essential Job Responsibilities:

  • ​Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts.
  • Follows up on all claims requiring prior authorization within 4-5 business days. 
  • Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis. 
  • Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on. 
  • Assists Billing Department with resolving unbilled claims at each month end close.  
  • Advocates for clients as needed. 
  • Support for Pharmacy Operations.
  • Adjudicates and resolution of claim rejections as needed. 
  • Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis. 
  •  Other responsibilities as assigned.

Position Requirements

  • High School Diploma/GED required
  • Kentucky Pharmacy Tech License preferred
  • Excellent customer service and communication skills, both written and verbal.
  • Ability to prioritize and meet pre-determined deadlines.
  • Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills.
  • Experience in healthcare billing environment (pharmacy preferred)
  • Familiarization with on-line claims processing and Medicaid and Medicare billing practices.  
  •  Proficient with Microsoft Word & Excel required.

Additional Information


Our Company offers a comprehensive benefits package to full-time employees including medical, dental, vision, paid time off, disability, life, and tuition reimbursement. All employees age 21 and older are eligible to participate in the 401(k) retirement savings plan.

ResCare is an Equal Opportunity Employer. ResCare does not discriminate against any person on the basis of gender, race, color, national origin, religion, disability, age, veteran status, gender identity or sexual orientation in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of gender in its health programs and activities.