Prior Authorization Specialist

About the role

CareMed Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join their dedicated team in Louisville, KY. This is a full-time position ideal for candidates local to the area. Remote work is possible after initial on-site training.

Responsibilities

• 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.
• Maintain accurate documentation of authorization details.
• Proactively monitor and renew expiring authorizations.

Requirements

• 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

Qualifications

• Associate degree or Certified Pharmacy Technician (PTCB)
• 3+ years of experience in pharmacy or prior authorizations
• Specialty pharmacy experience

Skills

• Strong communication skills
• Organizational skills
• Customer service skills
• Detail-oriented
• Adaptable to changing priorities
• Knowledge of pharmacy terminology
• Experience with insurance claims
• Experience with CoverMyMeds

Benefits

• Medical
• Dental
• Vision
• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Quarterly Incentive Bonus
• Paid Volunteer Day
• Referral Incentive Program
• Company Paid Life Insurance
• Short/Long-Term Disability

Pay

$23.00/hr and up

Schedule

Shift times currently available: 9:00am- 5:30pm EST or 9:30 - 6:00 pm EST

Company Values

• Teamwork
• Respect
• Integrity
• Passion