IL
LPN/LVN - Prior Authorization
ICONMA, LLC
- 🇺🇸 United States
- Remote
- 17 hours ago
- $16 – $26 / hour
- prior authorization
- LPN
17 hours ago
Not enough detail in this posting to match
Responsibilities:
- Provide processing and communication of Commercial Prior Authorizations (PA) and Appeals reviewed by the Commercial PA and Appeals team for Pharmacy benefits.
- Working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status.
- You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria.
- Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and determinations, and making follow-up phone calls.
- Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.
- Review criteria-based prior authorizations/appeals following policy and procedure
- Provide internal nurse support to the PA/Appeals team and member services department Refer cases not meeting clinical criteria to the Pharmacist and MD team(s).
- Shift priorities while exhibiting a high level of urgency with all calls and assignments.
- Follow all prior authorization and appeals procedures to guarantee an accurate process on each prior authorization.
- Train and mentor representatives on the PA/Appeals team. Complete other PA/Appeals assignments as delegated by the PA/Appeals leadership team.
- Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
Requirements:
- Active unrestricted LPN/LVN license
- Minimum 6 months[s] [/s]prior authorization experience; Prior appeals experience is preferred
- PBM, specialty pharmacy, payer, or medical office (MDO) experience
- Experience reviewing and applying clinical criteria and supporting documentation for PAs
- Experience using CoverMyMeds or similar authorization platforms
- Familiarity with chart notes, claims history, and insurance requirements
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
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LPN/LVN - Prior Authorization · ICONMA, LLC