Job Description

Phyz Healthcare Solutions is a first to market prescription triage network that specializes in biotech data, analytics, and research.

At Phyz Healthcare Solutions, we pride ourselves on our dynamic team culture, flexible schedule, and competitive benefit package. Our company foundation is built on empowering our team to utilize their talent and skill set in a rewarding environment that is accommodating. We are looking to expand our team as the constant demand for our solutions increase. Currently, we are seeking a Solutions Specialist in Prior Authorizations to join our team.

As part of the Triage Solutions (i.e. our Operations team that processes prescription prior authorization requests and interacts with Physician’s offices, Specialty Pharmacies, Payers, etc.). The Solutions Specialist is responsible for the daily contact with pharmacies, Physician’s and Physicians.

Reporting to the Director of Operations, the Solutions Specialist is to ensure a streamlined process for the course of the prescriptions.

ESSENTIAL RESPONSIBILITIES:

· Confirm accurate and timely completion of prior authorizations to the insurance payers utilizing the OPS portal, CoverMyMeds, and necessary platforms.

· Accurate and timely completion of appeals and clinical paperwork for physician offices.

· Send all updates/forms to physician and payer for necessary completion.

· Follow up on all claims requiring prior authorization within 1-2 business days.

· Utilize proprietary software to manage workflow and patient notifications.

· Reviews proprietary software for workflow and tracking of open prior authorizations, appeals and expiration dates.

· Follow the standards within the Policies & Procedures manual.

BASIC QUALIFICATIONS:

· Previous experience in pharmacy related billing is a plus

· High School diploma

· Familiar with online claims process (including Medicaid & Medicare billing practices).

· Strong organizational, interpersonal and communication skills.

· Ability to pay close attention to detail.

· Advanced personal computer skills, including Microsoft Office is required.

PHYSICAL REQUIREMENTS:

· The employee is required to regularly stand, walk, and sit, as well as talk and hear.

· The employee is required to use hands to operate vehicles and office equipment.

· The employee must occasionally lift and/or move up to 20 pounds.

· Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and the ability to adjust focus.

Company Description

Phyz Healthcare Solutions is a digital health company powered by our intelligent routing solutions. Phyz improves biotech brand access by better supporting patients and Prescribers with event-triggered interventions throughout the Rx life-cycle.