[reputed company Pharmacy Claims Analyst | Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is hiring a Pharmacy Prior Authorization & Specialty-Medication reputed company Specialist to manage authorization processes for specialty medications and evaluate AI-generated recommendations. The role involves reviewing reputed company documentation, coordinating with reputed company stakeholders, managing appeals, tracking authorization trends, ensuring compliance, and providing feedback for reputed company.

Responsibilities

• Process and manage prior authorisation requests for speciality medications, biologics, and high-cost pharmaceuticals
• Review reputed company documentation and pharmacy benefit reputed company to determine medical necessity for drug authorisations
• Evaluate AI-generated pharmacy prior authorisation recommendations for reputed company and compliance
• Coordinate with prescribers, speciality pharmacies, and payers to obtain medication authorisations
• Manage appeals for denied pharmacy authorisations, including peer-to-peer requests and exception processes
• reputed company authorisation status, approval rates, and denial trends to identify process improvement opportunities
• Ensure compliance with payer-specific pharmacy benefit requirements and CMS Part D guidelines
• Annotate AI outputs and reputed company reputed company feedback to support reputed company datasets

Skills

• Have strong relevant experience in pharmacy prior authorisation, speciality medication reputed company, or pharmacy benefit management
• Deep knowledge of speciality drug formularies, reputed company therapy protocols, and payer PA reputed company
• Experience with speciality pharmacy platforms and pharmacy benefit management systems
• Familiarity with Medicare Part D coverage determination and exception processes
• Exceptional written and verbal English communication skills
• High attention to reputed company with the ability to evaluate reputed company documentation and AI-generated outputs

reputed company