Product Support – QA Specialist

Role Overview

• Conduct comprehensive research using electronic sources, such as databases and online repositories, to identify and validate prior authorization (PA) forms for all relevant products.
• Build and maintain digital assets, including electronic prior authorization (ePA) forms and various correspondence materials, using internal proprietary systems.
• Test system modifications and new functionality to ensure accuracy and readiness for implementation; document and report software defects to developers or relevant departments.
• Participate in product design and development discussions, providing detailed input on functional requirements, usability, and potential risk areas.
• Analyze payer-provided content to create cohesive and compliant question sets, ensuring alignment with clinical and regulatory standards.
• Utilize basic clinical knowledge to correctly associate PA forms with appropriate products, therapeutic areas, and use cases.
• Create, edit, and maintain PDFs using Adobe Acrobat DC Pro to ensure proper formatting, accessibility, and compliance.
• Adhere to all applicable data privacy, security, and compliance standards, including HIPAA and internal data governance policies.
• Work independently to manage assigned tasks, meet deadlines, and maintain a high standard of quality across all deliverables.
• Support continuous improvement initiatives by identifying opportunities for increased efficiency, accuracy, and automation in form development and quality assurance processes.

Requirements

• Solid understanding of prescription drug reimbursement processes, including insurance plan types, major medical benefits, and prior authorization requirements.
• Basic knowledge of prescription drugs, including administration methods, routes, dosages, dosage forms, and common drug classifications.
• Proficient in the use of computers and software applications, including Microsoft Office Suite, Adobe Acrobat, web-based platforms, and general keyboarding skills.
• Ability to quickly adapt to new systems, workflows, and technologies, and learn company-specific policies and procedures effectively.
• Exceptional attention to detail with the ability to perform repetitive tasks with a high degree of accuracy and consistency.
• Strong written and verbal communication skills to document, explain, and collaborate on technical or process-related information clearly and professionally.
• Excellent interpersonal skills, with the ability to collaborate effectively across diverse teams and work with individuals from various backgrounds.
• Prior experience in Specialty Pharmacy or Managed Care, with a working knowledge of specialty medications and the associated prior authorization process.
• Bachelor’s degree in healthcare, life sciences, pharmacy, health information management, or a related field.
• Previous experience working with electronic prior authorization (ePA) systems or pharmacy benefit management (PBM) platforms.
• Familiarity with industry-standard coding systems such as NDC, HCPCS, or ICD-10.
• Understanding of payer policies and utilization management criteria for specialty medications.
• Experience conducting quality assurance reviews and documenting process improvements.
• Proficiency with Adobe Acrobat DC Pro for creating and editing accessible, fillable PDFs.
• Demonstrated ability to manage multiple projects or tasks simultaneously while meeting tight deadlines.
• Experience in a remote or hybrid work environment with minimal supervision.
• Familiarity with HIPAA and other healthcare data privacy regulations.
• Knowledge of clinical terminology and medical benefit coverage criteria.

Benefits

• Work Hard, Play Hard: Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary. Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
• Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
• Flexible Culture: Many associates earn the opportunity to work a hybrid schedule after 120 days after training. Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
• Career Growth: We prioritize a “promote from within mentality”. We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
• Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
• Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible.
• Medical, dental, vision, life, & short-term disability insurance
• Teledoc services for those enrolled in medical insurance
• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Legal insurance