Prior Authorization Representative

Company Name:
Express Scripts
Advance your career with the company that makes it easier for people to choose better health.
Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.
Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.
A leading provider of specialty pharmacy services, Accredo improves care for patients through behavioral and clinical expertise.
Accredo offers a broad range of healthcare products and services for individuals with chronic health conditions, such as growth hormone deficiencies, hepatitis C, hemophilia, oncology, multiple sclerosis and rheumatoid arthritis. It also provides comprehensive patient management services, including clinical care management programs, counseling, education, outcomes measurement, social services and reimbursement services.
Review requests from doctors and pharmacists to determine whether medication coverage prior authorization can be given by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria
Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.
Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions.
Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement.
Work collaboratively with other associates and supervisor to ensure that best practices are shared.
Other special projects as assigned.
Qualifications :
Formal Education and/or Training:
High School Diploma or GED
Years of Experience:
2 - 3 years of experience
Computer or Other Skills:
Conflict resolution skills; excellent organizational skills; Superior written and verbal communication and presentation skills; Strong interpersonal skills
Knowledge and Abilities:
Ability to handle challenging customers in a professional manner; Ability to adapt in a dynamic work environment learns quickly, solve problems and make decisions; Willingness to work a flexible schedule for peak call times
Job Category: Client Services
Primary Location: United States-Tennessee-Nashville
Work Locations: Nashville, TN - 201 Great Circle Road (5307)201 Great Circle RoadNashville, 37228
Schedule: Full-time
Shift: 1st Shift
Employee Status: Regular
Travel: No
Work From Home?: No

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