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Express Scripts Prior Authorization Jobs in Tennessee

Vein Guys

Medical Office Manager

Hendersonville, TN · On-site

Advanced knowledge of pre-certification, prior authorization, and medical necessity documentation ... DFWP Opportunities posted here do not create any implied or express employment contract between you ...

New

Express

Assistant Manager

Bartlett, TN · On-site

About Express Express is a multichannel apparel brand dedicated to a design philosophy rooted in ... Prior sales management experience BENEFITS AND COMPENSATION PHOENIX offers a range of benefits to ...

Express

Assistant Manager

Bartlett, TN

About Express Express is a multichannel apparel brand dedicated to a design philosophy rooted in ... Applicants must be currently authorized to work full-time in the United States. PHOENIX does not ...

Honorhealth

... scripts and any other pertinent paperwork. * Responsible for adhering to all third party payer ... Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the ...

Honorhealth

... scripts and any other pertinent paperwork. * Responsible for adhering to all third party payer ... Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the ...

Express & Bonobos

Assistant Manager

Bartlett, TN · On-site

About Express Express is a multichannel apparel brand dedicated to a design philosophy rooted in ... Prior sales management experience BENEFITS AND COMPENSATION PHOENIX offers a range of benefits to ...

Cybercoders

Symitar Developer

Memphis, TN · On-site

The role focuses on authoring PowerOn scripts and working with the Symitar core platform, building ... Prior experience in financial services or credit unions is a plus; professional certifications ...

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Express Scripts Prior Authorization information

What are the key skills and qualifications needed to thrive in the Express Scripts Prior Authorization position, and why are they important?

To thrive as an Express Scripts Prior Authorization specialist, you typically need a background in pharmacy or healthcare, knowledge of prescription drug protocols, and experience with insurance processes. Familiarity with pharmacy benefit management (PBM) software, electronic health records (EHRs), and prior authorization platforms is important, as are any relevant pharmacy technician certifications. Strong attention to detail, excellent customer service abilities, and effective communication set top performers apart in this position. These skills ensure accurate and timely authorization processing, minimize errors, and support both patient care and pharmacy operations.

What are the main responsibilities of an Express Scripts Prior Authorization specialist on a daily basis?

An Express Scripts Prior Authorization specialist is responsible for reviewing prescription requests, evaluating clinical information, and coordinating with prescribers, patients, and insurance providers to determine coverage eligibility. This role involves managing a high volume of cases, using proprietary systems to document and process authorizations, and frequently communicating via phone and electronic correspondence. Specialists must balance accuracy and efficiency while navigating complex healthcare regulations and helping resolve any issues that arise for patients facing prescription coverage barriers. The position often requires collaboration with pharmacists, physicians, and customer service teams to ensure seamless patient care.

What is an Express Scripts Prior Authorization job?

An Express Scripts Prior Authorization job involves reviewing medication requests to ensure they meet insurance plan requirements before approval. Employees in this role assess prescriptions, follow clinical guidelines, and collaborate with healthcare providers to determine coverage eligibility. The job requires attention to detail, knowledge of pharmacy benefits, and strong communication skills. It helps ensure patients receive the most appropriate and cost-effective medications.

What are popular job titles related to Express Scripts Prior Authorization jobs in Tennessee? For Express Scripts Prior Authorization jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Express Scripts Prior Authorization jobs in Tennessee look for? The top searched job categories for Express Scripts Prior Authorization jobs in Tennessee are:
Express Scripts Prior Authorization jobs near you
Medical Office Manager

Medical Office Manager

Vein Guys

Hendersonville, TN • On-site

Full-time

Posted 23 hours ago

Job description

The Medical Office Manager is responsible for the comprehensive operational success of the surgical practice, with a specialized focus on the patient journey and surgical coordination. This role is the "hub" of the practice, bridging the gap between patient intake, complex surgical scheduling, and the rigorous pre-certification requirements necessary to maintain practice workflow.Key ResponsibilitiesPatient Coordination & Front-End Operations
  • Check-In/Check-Out Management: Oversee the front desk workflow to ensure a seamless patient experience, including accurate demographic collection, insurance verification, and final patient processing.
  • Patient Advocacy: Act as the primary point of contact for patient inquiries, ensuring expectations are set regarding surgical prep, arrival times, and post-operative follow-up.
  • EHR Management: Ensure all patient charts are audited for accuracy and completeness during the intake and checkout phases to maintain high standards of record integrity.
Surgical Scheduling & Pre-Certification
  • Surgical Coordination: Manage the master surgery schedule, coordinating between clinical providers, facility availability (e.g., Swan Surgical), and patient schedules.
  • Pre-Certification & Authorization: Serve as the lead on navigating insurance payer requirements. Initiate, track, and secure pre-certifications for all surgical procedures and diagnostic tests.
  • Denial Prevention: Monitor the status of pending authorizations; proactively address issues with insurance carriers to prevent delays or rescheduling of surgery dates.
Operational & Financial Oversight
  • Financial Integrity: Oversee the accurate collection of co-pays, deductibles, and surgical deposits at the time of service.
  • Budgeting & Reporting: Monitor daily revenue cycle performance, ensuring that surgical volume data is tracked and reported accurately for practice management.
  • Compliance: Maintain strict adherence to HIPAA guidelines regarding patient privacy, particularly during the transition of medical records to hospitals or ancillary surgical facilities.
Required Skills & Qualifications
  • Surgical Scheduling Expertise: Demonstrated experience in managing the logistics of surgical scheduling, including coordination with outside hospitals or surgical centers.
  • Insurance Proficiency: Advanced knowledge of pre-certification, prior authorization, and medical necessity documentation requirements for private and public payers.
  • Operational Detail: Strong organizational skills with the ability to manage front-office traffic while simultaneously tracking long-lead surgical authorizations.
  • Software Proficiency: Deep familiarity with practice management and EHR software; ability to generate reports on surgical volume and authorization turnaround times.
  • Communication: Exceptional phone and interpersonal skills to handle patient anxiety regarding surgeries and to advocate effectively with insurance adjusters.

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.  

No Third Party Agencies or Submissions Will Be Accepted.  

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP  

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.


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