Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards. Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed. Collaborates with other departments to assist in obtaining prior authorizations/appeals. Documents insurance company interactions and all prior authorization information in the system. Reviews insurance denials and submits appeals as permitted by payor. Contacts physician offices as needed to obtain demographic information or medical data. Minimum Requirements: Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experiences:Specialty pharmacy experience highly preferred. Medical terminology training is preferred. Prior Authorization experience is highly desired. Use critical thinking to interpret oncology regimens and supporting clinical documentation, anticipates payer criteria (e.g., step therapy, site-of-care, NCCN-guided rationale), and determine the best authorization strategy and next step is desired. Job Level:Non-Management Non-Exempt. Workshift:2nd Shift (United States of America)