Prior Authorization Audit Specialist I

MedImpact Healthcare Systems • San Diego, CA

392d • $45,984 - $75,415

About The Position

The Prior Authorization Audit Specialist I at MedImpact Healthcare Systems is responsible for assessing the quality of Clinical Prior Authorizations processed by pharmacy technicians and data entry clerks. This role involves conducting audits, advising management on quality assurance results, and ensuring compliance with established standards and regulations. The specialist will work under general supervision, utilizing predefined audit criteria and guidelines to perform their duties effectively. The position also requires collaboration with various departments to track and report on prior authorization cases, ensuring timely and accurate processing in accordance with regulatory requirements.

Requirements

• Associate's degree (A.A.) or equivalent from a two-year college or technical school; or 1-3 years of related experience and/or training; or equivalent combination of education and experience.
• Current Pharmacy Technician License and/or CPhT Certification without restriction.
• Experience writing SQL queries and/or MedOptimize experience is preferred.
• Proficiency with Windows-based database programs is required.

Nice To Haves

• PBM, Health Plan, or Health Care background preferred.
• Articulate 360 experience preferred.
• MedAccess & MedResponse experience is preferred.

Responsibilities

• Conduct internal audits of PA staff's work to ensure compliance with MedImpact's audit criteria and regulatory requirements.
• Perform audits to ensure accurate and timely information is documented and provided.
• Audit Technical Call Center for Quality Assurance measurements.
• Identify and recommend improvements for workflow processes and training programs.
• Provide feedback and training to staff based on individual audit results.
• Generate SQL queries to report client-specific data and PART-D status to management.
• Compile detailed audit reports summarizing results for performance ratings and compliance oversight.
• Act as a subject matter expert regarding PART D PA processing and timeliness.
• Author monthly Required Training Lessons for PACs and Data Entry Clerks.
• Monitor and report untimely PART D cases identified after hours.

Benefits

• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• Tuition reimbursement
• Paid time off
• Vision insurance
• 401(k) matching
• Life insurance
• Referral program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree