Prior Authorization Specialist

A Prior Authorization Specialist at PHIL is responsible for verifying patient insurance coverage, submitting prior authorizations in a timely manner through electronic portals, and troubleshooting any prescription processing issues with healthcare providers. This role also involves providing phone and email support to ensure that all necessary information is collected for efficient authorization requests.

To be a Prior Authorization Specialist at PHIL, candidates should have experience in prior authorizations, medical insurance billing, or health insurance. Strong written and verbal communication skills and the ability to adapt to new systems and workflows are essential. Additionally, customer service experience and a familiarity with ICD-10 codes and prescription drug names are preferred.

As a Prior Authorization Specialist at PHIL, you play a crucial role in improving medication adherence by ensuring patients receive their medications on time. This involves efficiently navigating the prior authorization process, communicating effectively with healthcare providers, and troubleshooting any potential barriers to access.

Yes, PHIL allows Prior Authorization Specialists the flexibility to work remotely, provided they have reliable high-speed internet access. However, candidates must also be willing to work in the office as required, ensuring a balanced approach to team collaboration and support.

PHIL offers a comprehensive benefits package for Prior Authorization Specialists, including medical, dental, and vision insurance, as well as a 401(k) contribution opportunity. Additionally, this position provides a unique chance to be part of a rapidly growing startup in health-tech, making a difference in patients' lives.

The prior authorization process involves verifying patient eligibility for medications, collecting necessary medical documentation, and submitting requests to insurance companies. When answering this question, outline the steps involved and emphasize your organizational skills to manage timelines effectively.

Discuss any relevant experience you have in handling insurance claims or authorizations. Highlight specific instances where you successfully navigated complex insurance processes or resolved issues, showcasing your communication skills and persistence.

Explain your approach to managing stress and meeting deadlines, sharing techniques such as prioritizing tasks, maintaining open communication with team members, and utilizing organizational tools to ensure efficiency and accuracy.

In this scenario, discuss your strategies for follow-up communication and emphasize the importance of professional persistence. Mention how you would document all communications and consider alternative routes to ensure patient access to medication.

List the software systems you have used in prior authorization or medical billing. If possible, mention specific programs known for managing workflows and document tracking, demonstrating your tech-savviness and ability to adapt to new tools.

Share a specific example where you effectively engaged with a patient or provider to troubleshoot an issue. Highlight your communication skills and problem-solving abilities that led to a positive outcome, reflecting your dedication to patient care.

Discuss how exceptional customer service contributes to the overall patient experience, particularly in prior authorization. Emphasize your commitment to ensuring that all communications are clear, empathetic, and supportive.

Share your methods for staying organized, such as using task lists, calendar reminders, or tracking software. Illustrate how your system allows you to prioritize tasks efficiently and maintain accuracy throughout the process.

Identify common challenges in the role, such as navigating evolving insurance policies or managing provider relations. Discuss your proactive approach to overcoming these challenges through continual learning and adapting strategies.

Express your enthusiasm for PHIL's mission to improve patient access to specialty medications. Reflect on how the company's innovative approach to healthcare aligns with your personal values and career goals, highlighting your desire to contribute to meaningful change.