JOB REQUIREMENTS: Putting People First in Pharmacy- Navitus was foundedas an alternative to traditional pharmacy benefit manager (PBM) models.We are committed to removing cost from the drug supply chain to makemedications more affordable for the people who need them. At Navitus,our team members work in an environment that celebrates diversity,fosters creativity and encourages growth. We welcome new ideas and sharea passion for excellent service to our customers and each other. Due togrowth, we are adding this MedicarePrior Authorization SpecialistI toour MS Prior Authorization department. The Medicare Prior AuthorizationSpecialist I (MPAS I) will review, process, and troubleshoot incomingMedicare Coverage Determination requests for various medications andagainst a wide variety of pharmacy benefits, CMS defined regulatoryrequirements, and formularies. The MPAS I will accurately process therequests according to stringent regulatory and client specifications,which include short turnaround times, unique processes, and withabsolute accuracy. The MPAS I will work with other team members to meetthe departmental performance metrics and maintain compliance. The MPAS Iwill work with clinical to ensure requests are processed accurately andtimely. The MPAS I will process requests received via phone, fax, ePA,and web submission. The Medicare Prior Authorization Specialist I (MPASI) will be proficient in the Navitus claim processing system, the PAProcessing System, knowledge management application, and Intranet. TheMPAS I will be proficient in navigating across multiple systems andresources to gather and document benefit and formulary specifications.The MPAS I will gain proficiency in understanding, applying, andcommunicating client-specific formularies, clinical programs, regulatoryguidance, and other pharmacy benefit components. The MPAS I will followall CMS required regulations to ensure accuracy and compliance in 100%of the work performed in Medicare Prior Authorization Specialist role.The MPAS I will understand and apply deep subject matter expertiserelated to Medicare Part D rules and regulations specific to CoverageDeterminations, Redeterminations, and IRE processes. Is this you? Findout more below! How do I make an impact on my team? Research and analyzepharmacy claim rejections. Ensure the Coverage Determination request isnecessary or appropriate based on rejections, claim history, and systemmessaging. Aid members, providers, and Appointed Representatives viaphone in submitting Coverage Determination requests, provide formularyproduct information, communicate prior authorization request status,communicate criteria for approval, and communicate and/or gather theadditional information needed to process a request Create case fileswithin Prior Authorization... For full info follow application link.Navitus Health Solutions is an Equal Opportunity Employer:Disabled/Veterans/Male/Female/Minority/Other ***** APPLICATIONINSTRUCTIONS: Apply Online: ipc.us/t/74A4363D8ED9475A