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Pharmacy Prior Authorization Coordinator I
Location
United States
Posted
12 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Pharmacy Prior Authorization Coordinator I
Sentara Health
Role Description The Pharmacy Prior Authorization Coordinator delivers high-quality customer service by managing calls from members, providers, and pharmacies while processing pharmacy benefit prior authorization (PA) requests with accuracy and compliance. Working under general supervision, the Coordinator uses established protocols, business systems, and clinical guidelines to: - Analyze requests - Enter data for claims adjudication - Determine appropriate actions such as approval, pending, or referral This role requires strong reasoning and communication skills to ensure timely, efficient, and consistent service delivery in collaboration with internal teams and external partners. Key Responsibilities - Review and process pharmacy prior authorization requests using established guidelines - Verify member eligibility and pharmacy benefit coverage - Communicate PA status updates to members, providers, and pharmacies - Identify and resolve missing or incomplete information - Ensure requests are completed within required turnaround times (TAT) and performance guarantees - Document PA decisions clearly and accurately - Collaborate with internal pharmacy teams to resolve inquiries - Maintain confidentiality and data security at all times This position requires strong attention to detail, critical thinking, and excellent communication skills to deliver consistent, high-quality service in a fast-paced environment. Qualifications - High School Diploma or GED strongly preferred - Certified Pharmacy Technician (CPhT) preferred - 1 year healthcare experience REQUIRED - Pharmacy OR Prior Authorization or Call Center experience highly preferred Benefits - Medical, Dental, Vision plans - Adoption, Fertility and Surrogacy Reimbursement up to $10,000 - Paid Time Off and Sick Leave - Paid Parental & Family Caregiver Leave - Emergency Backup Care - Long-Term, Short-Term Disability, and Critical Illness plans - Life Insurance - 401k/403B with Employer Match - Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education - Student Debt Pay Down – $10,000 - Reimbursement for certifications and free access to complete CEUs and professional development - Pet Insurance - Legal Resources Plan - Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met
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