BRSi

Pharmacist

• Coordinate prior authorizations, insurance verifications, medication approvals, and medical service approvals to support timely patient care and accurate reimbursement.
• Work closely with providers, pharmacies, insurance companies, and internal clinical or billing teams to obtain required approvals, resolve authorization issues, and maintain complete documentation.
• Review provider orders, prescriptions, medical records, and insurance requirements to determine whether prior authorization is needed.
• Submit authorization requests for medications, diagnostic testing, procedures, durable medical equipment, and other covered services.
• Verify patient insurance eligibility, benefits, coverage limitations, deductibles, copays, and payer-specific authorization requirements.
• Communicate with insurance companies, pharmacy benefit managers, pharmacies, provider offices, and patients to obtain missing information and follow up on pending requests.
• Document authorization status, approvals, denials, appeals, reference numbers, effective dates, and follow-up actions accurately in the appropriate system.
• Track authorization requests to ensure timely completion and reduce delays in treatment, medication access, or scheduled services.
• Research and resolve authorization denials, discrepancies, claim issues, and payer requests for additional documentation.
• Assist with appeals, reconsiderations, peer-to-peer coordination, and resubmission of corrected authorization requests when needed.
• Maintain compliance with HIPAA, payer policies, organizational procedures, and applicable healthcare regulations.
• Collaborate with billing, clinical, pharmacy, scheduling, and patient services teams to support continuity of care and revenue cycle efficiency.

Pharmacy Authorization Specialist

Revenue Cycle Specialist

• Review and work assigned accounts to resolve denied, underpaid, and unpaid insurance claims.
• Analyze payer responses, remittance advice, and denial codes to determine the appropriate resolution.
• Correct and rebill claims as needed to ensure accurate claim submission.
• Prepare and submit appeals for underpayments and erroneous denials with appropriate supporting documentation.
• Contact insurance carriers to obtain claim status, clarify denials, and facilitate payment.
• Document all account activity, payer communications, and follow-up actions in the billing system.
• Monitor accounts to ensure timely follow-up and resolution within established productivity standards.
• Identify payer trends and recurring billing issues and communicate findings to management.
• Collaborate with internal departments to resolve claim edits, coding, registration, or documentation issues affecting reimbursement.
• Maintain knowledge of payer policies, reimbursement guidelines, and applicable regulations.
• Meet productivity and quality goals while maintaining a high level of accuracy and attention to detail.
• Perform other revenue cycle duties as assigned.