Available Position (Company name withheld)

Careers with real impact.

Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.

ABOUT ORSINI

Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™

OUR MISSION

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.  

CORE VALUES

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.  

COMPENSATION & LOCATION

The salary range for this role is $25.00

This position is based out of Elk Grove Village, IL. 

POSITION SUMMARY

The Sr. Prior Authorization Representative will work closely within the Admissions department processing patient drug referral prior authorization (PA) requests, performing status checks, validating payor requirements for assigned drugs, contacting provider offices, and other related functions. In addition, the Senior Prior Authorization role will be responsible for training new Prior Authorization employees on department processes, procedures and company software systems. This role will be a key resource for on-going training and development needs for the Prior Authorization team and has expert knowledge with pharmacy and medical prior authorization submissions, benefit verification process, excel spreadsheets and medical policies.

ESSENTIAL DUTIES

• Contact plans (PBM or Major Medical) to validate request sent from BV Team.
• Contact physician’s office to obtain current prescriptions.
• Contact physician’s office to obtain clinical documentation that is required by the plans.
• Validate that the clinical documentation received is what is required by the plan.
• Initiate prior authorization request to the major medical plans via fax or plan portals.
• Initiate prior authorizations request through Cover My Meds for pharmacy benefit request.
• Follow up on all pending PA’s within 48 hours.
• Respond to urgent emails submitted by the PCC Team or Program Manager in a timely manner.
• Obtain approval/ denial letters.
• Submit all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.
• Initiate re-authorizations that are set to expire 30 days prior to the term date.
• Train new hires on our prior authorization process through the major medical and pharmacy benefit.
• Submit New Start spreadsheet to the prior authorization team in a timely manner.
• Ensure that all New Start updates has been received and merge updates in a timely manner.
• Maintain the New Start spreadsheet.
• Ability to create an accurate profit and loss for medical and pharmacy benefits.
• Other duties and responsibilities as required.    

KNOWLEDGE, SKILLS, AND TRAINING

• Experience with Major Medical Insurances.
• Experience with Pharmacy Benefits.
• Knowledge of HCPC Codes (J-Codes).
• Knowledge of ICD-10 Codes (Diagnoses Codes).
• Familiar with medical documentation such as H&P’s, Genetic testing, Labs etc.
• Ability to read prescriptions.
• Ability to convert a prescription into an authorization request based on payer requirements.
• Ability to interpret medical policies.
• Ability to assist and train new staff.

• Medical Coverage, Dental, and Vision Coverage
• 401(k) with employer match
• Accident and Critical Illness coverage
• Company-paid life insurance options
• Generous PTO, paid holidays, and floating holidays
• Tuition reimbursement program.

Equal Employment Opportunity

Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.

Americans with Disabilities Act

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

E-Verify Participation Notice

We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees.

All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system.

For more information about E-Verify, please review the official notices below:

E-Verify Participation Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf

Right to Work Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf