Prior Authorization Specialist

What You’ll Do

• 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

• A High School Diploma or GED.
• 1+ years of pharmacy or prior authorization experience.
• 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.
• A Preferred Associate degree or Certified Pharmacy Technician (PTCB).
• 3+ years of experience in pharmacy or prior authorizations.
• Specialty pharmacy experience.