Prior Authorization Lead

At Express Scripts we believe in practicing pharmacy smarter. We put medicine within reach of tens of millions of people by aligning with our customers, taking bold action and delivering patient-centered care to make better health more affordable and accessible.

Oversee lead responsibilities for the Service Delivery Units daily shipment completion, invoice editing, and report reconciliations. Works under the direction of the Supervisor and/or Manager, and serves to support staff in attainment of goals as well as completion of daily activities. Performs training/retraining tasks, patient access audits and other duties as assigned by management. Assist with efficient resolution of member and client related issues. Act as liaison services to other Express Scripts Departments. Recognizes and recommends improvements to processes and procedures.

* Assist the Supervisor and/or Manager in monitoring the front-end reimbursement function from the insurance verification stage through the shipment completion stage (and through invoice editing where applicable). Function as a “hands on” subject matter expert for the Department. * Review Department activities and identify potential issues or areas of risk, and bring these to the attention of the Supervisor and/or Manager for timely resolution. Keep abreast of all new and updated policies and procedures as well as policy alerts. * Monitor Quality Assurance through the audit of referrals and the audit of RxHome patient accounts in intervals as dictated; Act as liaison for other operational departments to research and resolve member and client issues. Be responsible to screen, review and direct all Customer Service generated forms to appropriate internal areas facilitating member and client issues resolution * Maintain service levels and performance guarantees. Maintain accurate and complete documentation of all inquiries. * Provide support and backup for supervisors. Assist with work plan development and work distribution for SR Prior Auth Rep’s * Special projects as assigned

* High school or GED required; Bachelor’s Degree preferred * 3 – 5 years of relevant working experience; one year of health care experience with medical insurance knowledge and terminology. Basic supervisory skills desired. * Working knowledge of Microsoft Office * Extensive knowledge of ESI products and services a must * Experience training and coaching less experienced staff – patience to explain details and processes repeatedly, excellent phone presentation and communication skills. * Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervisor. * Advance problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions.