Prior Authorization Specialist - Remote

Medical/Healthcare Elk Grove, Illinois


About Orsini Specialty Pharmacy 
Providing patients with comprehensive and compassionate care since 1987, Orsini Specialty Pharmacy is a leader in rare diseases and gene therapies. Orsini partners with biopharma innovators, healthcare providers, and payors to support patients and their families in accessing revolutionary treatments for rare diseases. Through integrated pharmacy distribution, patient services, clinical management and convenient home infusion services, Orsini delivers customized solutions that simplify how patients connect to advanced therapies. Orsini’s high-touch care model centers on experienced and trained therapy care teams that provide personalized patient care to ensure that No Patient is Left Behind™. Orsini Specialty Pharmacy holds accreditations with the Accreditation Commission for Health Care (ACHC), The Joint Commission, URAC and NABP. Orsini has earned URAC’s Rare Disease Pharmacy Center of Excellence Designation and ACHC's Distinction in Rare Diseases and Orphan Drugs.  
Our Mission 
Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.  
LIVE IT Values 
At the heart of our company culture, the Orsini LIVE IT core values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.  
Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First 
Position Summary
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.

Required Knowledge, Skills & Training
  • Experience with Major Medical Insurance
  • Knowledge of Pharmacy Benefit
  • Knowledge of HCPC Codes (J-Codes)
  • Knowledge of ICD-10 Codes (Diagnoses Codes)
  • Familiar with medical documentation such as H&P’s, Genetic testing, etc.
  • Ability to read prescriptions
  • Ability to convert a prescription into an authorization request based on payer requirements
  • Ability to interpret medical policies
Essential Job Duties 
  • Contact plans (PBM or Major Medical) to validate request sent from BV
  • Contact physician’s office to obtain current prescriptions
  • Contact physician’s office to obtain clinical documentation that is required by the plans
  • Validate that the clinical documentation received is what is required by the plan
  • Initiate prior authorizations through Cover My Meds
  • Follow up on all pending PA’s within 48 hours
  • Respond to urgent emails submitted by the Patient Care Coordinator Team or Program Manager in a timely manner
  • Obtain approval / denial letters
  • Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process
  • Initiate re-authorizations that are set to expire 30 days prior to the term date
Employee Benefits 
  • BCBSL Medical
  • Delta Dental
  • EyeMed Vision
  • 401k
  • Accident & Critical Illness
  • Life Insurance
  • PTO, Holiday Pay, and Floating Holidays
  • Tuition Reimbursement