Prior Authorization Analyst Sr (Remote)

Other Jobs To Apply

No other job posts for this day.

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.
Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...