Pharmacy Prior Authorization Specialist

A career with purpose: Help patients access life-saving medications.

Supportive culture: We value teamwork, respect, integrity, and passion .

Growth opportunities: We invest in your professional and personal development.

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third-party authorization requests.

Manage prior authorization requests and appeals with insurance carriers.

Collaborate with physicians, pharmacists, and other departments.

Ensure HIPAA compliance while handling sensitive patient information.

Maintain accurate documentation of authorization details.

Proactively monitor and renew expiring authorizations.

Required:

High School Diploma or GED

1+ years of pharmacy or prior authorization experience

Pharmacy Technician License/Registration with Board of Pharmacy (as required by state law)

Strong communication, organizational, and customer service skills

Self-motivated, organized, detail-oriented, and adaptable to changing priorities

Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

Associate degree or Certified Pharmacy Technician (PTCB)

3+ years of experience in pharmacy or prior authorizations

Specialty pharmacy experience