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Overnight Prior Authorization Representative Express Scripts Jobs in Arizona

Arizona Priority Care

Prior Authorization Rep

Chandler, AZ · Hybrid

$39K - $54K/yr

The Prior Authorization Representative I is responsible for processing incoming requests including verifying eligibility and benefits and the data entry component of the prior authorization request.

GI Alliance

Prior Authorizations Rep (30486)

Glendale, AZ · On-site

$17.50 - $22.25/hr

Obtain authorization via payer website or by phone and follow up regularly on pending cases ... Minimum 1 year prior authorization experience * Understanding of payer medical policy guidelines to ...

GI Alliance

Prior Authorizations Rep (31182)

Glendale, AZ · On-site

$17.50 - $22.25/hr

Obtain authorization via payer website or by phone and follow up regularly on pending cases ... Minimum 1 year prior authorization experience * Understanding of payer medical policy guidelines to ...

SMI IMAGING LLC

Pre-Authorization Representative

Phoenix, AZ · On-site

$39K - $54K/yr

Obtains pre-certification and registration prior to a patient's appointment. * Gathers pertinent ... Provides ongoing communication with patient regarding authorization and scheduling process. * Has ...

All Ways Caring HomeCare

Overnight Caregiver

Flagstaff, AZ · On-site

$18.35 - $20/hr

Overview At All Ways Caring HomeCare our Overnight Caregivers play a crucial role in providing ... express your interest by applying to join our awesome team today! Qualifications: * No prior ...

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Overnight Prior Authorization Representative Express Scripts information

What is an Overnight Prior Authorization Representative at Express Scripts?

An Overnight Prior Authorization Representative at Express Scripts is responsible for processing and evaluating prescription medication requests that require authorization from insurance providers, primarily during overnight shifts. This role involves reviewing clinical information, communicating with healthcare providers, and ensuring that medications meet insurance guidelines for approval. Representatives also provide customer service to patients, doctors, and pharmacists, helping to resolve issues and explain the prior authorization process. Working overnight means handling requests that come in outside of typical business hours, ensuring 24/7 support for patients and providers.

What are some common challenges faced by Overnight Prior Authorization Representatives at Express Scripts, and how can they be managed?

Overnight Prior Authorization Representatives at Express Scripts often face challenges such as managing high call volumes during off-peak hours, handling urgent medication requests, and working independently with limited on-site supervision. To manage these challenges, representatives should develop strong organizational skills, remain updated on the latest formulary guidelines, and leverage internal resources or escalation protocols for complex cases. Building effective communication with pharmacists, physicians, and other team members—even during overnight shifts—can also help ensure smooth case resolution and maintain high service quality.

What are the key skills and qualifications needed to thrive as an Overnight Prior Authorization Representative at Express Scripts, and why are they important?

To thrive as an Overnight Prior Authorization Representative at Express Scripts, you need a solid understanding of pharmacy benefits, medical terminology, and prior authorization processes, often supported by a high school diploma or equivalent and relevant experience in healthcare or pharmacy. Familiarity with pharmacy management software, claims processing systems, and Microsoft Office Suite is typically required. Attention to detail, strong problem-solving skills, and effective communication are critical soft skills for success in this position. These competencies ensure accurate and timely authorization decisions, safeguard patient access to medications, and uphold compliance with regulatory standards during overnight shifts.
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Overnight Prior Authorization Representative Express Scripts jobs near you
Prior Authorization Rep

Prior Authorization Rep

Arizona Priority Care

Chandler, AZ • Hybrid

$39K - $54K/yr

Full-time

Medical

Posted 6 days ago

Job description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Prior Authorization Representative I is responsible for processing incoming requests including verifying eligibility and benefits and the data entry component of the prior authorization request. The PA Rep I works closely with all UM Staff, Prior Auth Supervisor, and management to maintain turnaround time requirements of the contracted health plan, regulatory bodies, and internal goals. Routinely interacts with physicians, their office staff and internal customers.

POSITION DUTIES & RESPONSIBILITIES

  • Assist in managing the incoming prior authorization request by following work direction given by the Prior Authorization management to ensure Routine/Standard and Urgent/Expedited prior authorizations are processed in the appropriate amount of time and in compliance with regulatory and health plan requirements.
  • Complete a minimum data entry or adjudication of 40 authorizations per day.
  • Assist in reviewing and distributing incoming prior authorization requests including identifying Urgent/Expedited vs Routine/Standard, verifying member eligibility, delegated vs non-delegated services, retro vs. future date of services, accuracy checking documentation, and routing to appropriate folder.
  • Perform data entry of prior authorization requests with a minimum of 97% accuracy including primary insurance or hospice verification, determine if requested services require prior authorization, and confirm request is not duplicative.
  • Perform adjudication of authorization requests with a minimum of 97% accuracy including quality checking data entry, reviewing historical utilization management history to include program enrollment and verifying if rendering provider and facility is contracted, any tasks related to processing a prior authorization request (provider loads, out of network (OON) credentialing, accreditation verification, etc.), providing redirect information for OON requests, and routing to the appropriate queue or vendor.
  • Contact the provider's office for additional information per CMS and AZPC policies and guidelines.
  • Make expedited determination notifications to member and provider.
  • Provide exceptional, courteous, and professional phone customer service.
  • Educate practitioners as needed with the Authorization/Referral process.
  • Perform as necessary accommodate to departmental change, workload and emergencies.
  • Maintain current knowledge of CMS and NCQA standards, and AZPC UM Policies and procedures.
  • Protect privacy for patients, providers, and employees; ensure all personal health information is kept confidential.
  • Demonstrate caring, empathy, patience, respect and compassion for all team members.
  • Demonstrate honesty and integrity in everyday activities.
  • Perform other duties as directed by management.

EDUCATION, TRAINING AND EXPERIENCE

  • Highschool Diploma or GED – Required.
  • Minimum of 1-year administrative healthcare related experience – Required.
  • Proficient knowledge of medical terminology, CPT-4, HCPCS, and ICD-10 – Required.
  • Working knowledge of computer applications, such as Microsoft Office applications.
  • Excellent oral and written communication skills.
  • Demonstrated ability to be detail-oriented and multi-task effectively.
  • Able to interact effectively with all levels of staff.

*This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*