Prior Authorization
Prior Authorization is a common healthcare process where insurance companies require approval before covering certain medications or procedures. In pharmacy settings, it's a key responsibility where staff must obtain permission from insurance providers before dispensing specific medications. This process helps insurance companies ensure that expensive or specialized medications are being used appropriately and are medically necessary. The term might also appear as "PA," "pre-authorization," or "pre-approval" in job descriptions and resumes.
Examples in Resumes
Processed over 50 Prior Authorization requests daily with 95% approval rate
Managed Prior Authorization and Pre-Authorization workflow for specialty medications
Developed training materials for new staff on PA processing procedures
Typical job title: "Prior Authorization Specialists"
Also try searching for:
Where to Find Prior Authorization Specialists
Professional Organizations
Job Boards
Professional Networks
Example Interview Questions
Senior Level Questions
Q: How would you handle a complex Prior Authorization case that's been denied multiple times?
Expected Answer: A senior specialist should discuss strategies like gathering additional clinical documentation, coordinating with healthcare providers, understanding appeal processes, and knowing alternative medication options or assistance programs.
Q: How would you improve a Prior Authorization department's efficiency?
Expected Answer: Should mention implementing standardized processes, training programs, tracking metrics, utilizing available technology tools, and maintaining strong relationships with insurance providers and healthcare professionals.
Mid Level Questions
Q: What steps do you take when processing a Prior Authorization request?
Expected Answer: Should describe the complete workflow: gathering patient information, verifying insurance requirements, collecting necessary documentation, submitting requests, following up, and communicating with all parties involved.
Q: How do you stay updated with insurance companies' changing Prior Authorization requirements?
Expected Answer: Should discuss methods like regular review of insurance portals, attending training sessions, maintaining documentation of requirements, and networking with insurance representatives.
Junior Level Questions
Q: What is a Prior Authorization and why is it necessary?
Expected Answer: Should explain that it's an insurance requirement for certain medications, helping control costs and ensure appropriate use of medications, while demonstrating understanding of basic process steps.
Q: What information is typically needed for a Prior Authorization request?
Expected Answer: Should list basic requirements like patient demographics, insurance information, prescription details, diagnosis codes, and prescriber information.
Experience Level Indicators
Junior (0-2 years)
- Basic understanding of insurance requirements
- Data entry and form completion
- Phone communication skills
- Understanding of medical terminology
Mid (2-5 years)
- Processing complex authorization requests
- Insurance appeal processes
- Healthcare software systems
- Clinical documentation review
Senior (5+ years)
- Team leadership and training
- Process improvement
- Insurance policy expertise
- Healthcare regulation compliance
Red Flags to Watch For
- Limited knowledge of medical terminology
- Poor attention to detail in paperwork
- Weak communication skills
- No experience with healthcare software systems
- Lack of understanding about insurance requirements
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