Join Ascertain as a Prior Authorization Assistant in our Pharmacy division, where you will be at the heart of streamlining insurance processes to ensure patients receive timely access to essential medications. This role is pivotal in supporting our mission to deliver efficient healthcare solutions, reducing delays in treatment, and enhancing overall patient satisfaction while contributing to the company's growth in the insurance sector. In your daily responsibilities, you will review and process prior authorization requests for prescription medications, meticulously verifying patient eligibility, coverage details, and medical necessity against insurance guidelines. Weekly, you will collaborate with pharmacists, physicians, and insurance providers to gather required documentation, resolve discrepancies, and expedite approvals, often handling 50-100 requests per day. You will maintain accurate records in our proprietary pharmacy management systems, track authorization statuses, and generate reports on approval rates, denial reasons, and turnaround times to support team performance metrics. Monthly, you will participate in audits of authorization processes, identify bottlenecks, and propose improvements to enhance efficiency. Additionally, you will communicate directly with patients and healthcare teams to explain authorization outcomes, appeal denials when appropriate, and ensure compliance with HIPAA and state regulations. Expect to work closely with cross-functional teams including claims processing and customer service, occasionally leading small training sessions for new staff on authorization protocols. To succeed in this position, candidates must possess a high school diploma or equivalent, with an Associate's degree in healthcare administration, pharmacy technology, or a related field strongly preferred. At least 1-2 years of experience in pharmacy services, insurance claims, or prior authorization processing is required, ideally within a pharmacy benefit management or health insurance context. Proficiency in electronic health record (EHR) systems, pharmacy software such as QS/1 or PioneerRx, and Microsoft Office Suite is essential. Familiarity with formularies, NDC codes, and common insurance carriers like CVS Caremark, Express Scripts, or UnitedHealthcare is crucial. Relevant certifications such as Certified Pharmacy Technician (CPhT) or prior authorization specialist credentials will set you apart. Beyond technical expertise, you will bring strong organizational skills to manage high-volume workloads with precision and attention to detail. Excellent written and verbal communication abilities are key for interacting with diverse stakeholders, while problem-solving prowess helps navigate complex authorization challenges. Proficiency in medical terminology, data entry accuracy, and multitasking in a fast-paced environment rounds out the ideal skill set. Adaptability to evolving insurance policies and a customer-focused mindset ensure success in this collaborative role. Ascertain is a forward-thinking leader in insurance and pharmacy services, dedicated to innovating healthcare access through technology and exceptional service. Our mission centers on empowering patients and providers with reliable solutions. We foster a supportive team environment with collaborative departments spanning pharmacy operations, IT, and compliance. Our culture emphasizes work-life balance, continuous learning, and employee well-being in a modern, inclusive workspace. We offer competitive compensation, though salary details are not specified at this time, commensurate with experience. Comprehensive benefits include medical, dental, and vision insurance, 401(k) with company match, and generous paid time off starting at 15 days annually. Enjoy perks like flexible hybrid work options, professional development stipends, wellness programs, and performance-based bonuses to reward your contributions. Ascertain provides robust growth opportunities, from advancing to Prior Authorization Supervisor or Pharmacy Operations Manager to specialized training in regulatory compliance. We invest in your development through ongoing workshops and certifications. To apply, submit your resume via our careers portal today and take the next step in your healthcare career. (2097 characters)