Prior Authorization Specialist
Role Overview
This mid-level Prior Authorization Specialist role involves verifying patient insurance, submitting prior authorizations electronically, and troubleshooting issues with healthcare providers to ensure timely medication access. The specialist works closely with the Customer Support team, handling phone and email support, and requires independent problem-solving while contributing to patient adherence and operational efficiency in a health-tech startup environment.
Perks & Benefits
This is a remote position with Monday through Friday shifts, offering a ground-floor opportunity at a fast-growing health-tech startup with near-term profitability. Benefits include solving impactful problems in healthcare, access to reliable high-speed internet for remote work, and potential for career growth as the company plans to double its employee base, fostering a collaborative and mission-driven culture.
Full Job Description
PHIL is looking for a full-time Prior Authorization Specialist - with a focus on pharmacy support for Monday through Friday shifts.
About the Company:
Founded in 2015, PHIL is a San Francisco-based Series D health-tech startup, pioneering the first Software Therapy Deployment Platform for Specialty Pharmaceuticals that treat complex health conditions. Our mission is to ensure consistent, reliable and affordable access to complex therapeutics for our patient community. Partnering with pharmaceutical manufacturers, PHIL offers digital patient access services to improve health outcomes for patients by delivering affordable and timely access to high-cost Specialty therapeutics. We recently completed our Series D financing led by Warburg Pincus, with $122M in capital raised to date with near-term line of sight to profitability. Headquartered in Scottsdale with operational hubs in Scottsdale AZ and Columbus, OH, the company currently employs over 120 individuals and expects to double its employee base in the coming year. For more information on PHIL, visit https://phil.us/
Position Overview
The most important goal here at PHIL is to improve patients' medication adherence by offering a quick and effortless way for patients to get their medications on time. Prior Authorization Specialists ensure that prescribing offices have all of the information that they need in order to efficiently complete electronic coverage requests in addition to providing phone and email support.
Job Duties:
Verifies patient insurance coverage utilizing phone or online resources
Submit prior authorizations to insurance plans in a timely manner via electronic portal
Troubleshoots prior authorization submissions and prescription processing with health care providers utilizing phone or online resources
Verbally assist providers in navigating appeals processing
Ensures all pertinent medical documentation is accurate and present prior to authorization submission
Compiles trends in authorization determinations for client and prescriber education
Document activities appropriately in process notes using our operating system
Work closely with our Customer Support team to ensure the success of patients that are recommended to us by their physician's office
Requirements
Proven team player, but can solve problems independently as well
Exceptional written and verbal communication skills
Easily adapt to new system and workflow changes
Demonstrate experience working in prior authorizations, medical insurance billing, and/or health insurance (required)
Working knowledge of ICD-10 codes and prescription drug names (preferred, but not required)
Ability to successfully navigate between multiple systems throughout the course of the workday, this includes but is not limited to operational software and vendor portals
Demonstrate flexibility to perform duties wherever volume deems it necessary
Customer service experience (preferred)
Access to reliable, high-speed internet to meet the needs of remote processing (required)
Reliable transportation and ability to work in office as required
Benefits
Ground floor opportunity with one of the fastest-growing startups in health-tech
Solve a problem that matters: be part of a company that uniquely leverages technology to bring wellness to all of its stakeholders
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