Prior Authorization Specialist Remote

Orsini strives to be a trusted partner for biopharma innovators, healthcare providers, and payers, helping patients and their families access groundbreaking treatments for rare diseases. With an integrated portfolio of services, we aim to simplify access to advanced therapies while delivering compassionate, patient-centered care, ensuring that No Patient is Left Behind

Orsini’s culture is grounded in our core values, known as LIVE IT. These principles guide our interactions with colleagues, partners, and patients, driving our commitment to excellence and collaboration.

LIVE IT Values:

• Leading Quality
• Integrity
• Valued Partner
• Empathy
• Innovation
• Team-First

Position Overview

The Prior Authorization Representative works alongside the Benefits Verification Team to validate patients’ insurance coverage, prescriptions, and eligibility. Key responsibilities include interpreting prescriptions, initiating authorization requests, and analyzing medical policies. This role involves frequent communication with physician offices to gather clinical documentation and process prior authorizations efficiently.

Required Knowledge, Skills & Training

• Expertise in Major Medical Insurance
• Familiarity with Pharmacy Benefits
• Understanding of HCPC (J) Codes and ICD-10 Codes
• Ability to interpret prescriptions and convert them into authorization requests
• Knowledge of medical documentation, including histories, physicals, and genetic testing
• Competency in reviewing and applying payer-specific medical policies

Key Responsibilities

• Confirm requests submitted by the Benefits Verification team with insurance providers
• Communicate with physicians to validate prescriptions and obtain required clinical documentation
• Verify documentation aligns with insurance requirements
• Initiate prior authorization through systems like Cover My Meds
• Provide timely follow-ups for pending prior authorizations (within 48 hours)
• Respond promptly to urgent emails from care teams or program managers
• Handle approval or denial letters and submit them through the appropriate audit processes
• Manage re-authorizations for expiring approvals at least 30 days before the term date

Employee Benefits

Orsini offers a competitive benefits package that includes:

• Medical Insurance (BCBSL)
• Dental Coverage (Delta Dental)
• Vision Insurance (EyeMed Vision)
• 401(k) Retirement Plan
• Accident and Critical Illness Insurance
• Life Insurance
• Paid Time Off (PTO), Holiday Pay, and Floating Holidays
• Tuition Reimbursement