Prior Authorization Specialist

Job Description

Position Overview: We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team. The ideal candidate will have a strong background in pharmacy operations, prior authorization processes, and excellent communication skills. As a Prior Authorization Specialist, you will play a critical role in ensuring that patients receive timely approvals for medications, navigating insurance requirements, and collaborating with healthcare providers to optimize patient care.

Responsibilities:

Review prior authorization requests for medications to ensure completeness and accuracy.

Communicate with healthcare providers, insurance companies, and patients to gather necessary information for prior authorization submissions.

Verify insurance coverage and determine prior authorization requirements.

Complete and submit prior authorization forms according to insurance guidelines and requirements.

Follow up on prior authorization requests to ensure timely approvals and resolution of any issues or denials.

Maintain accurate documentation of prior authorization activities and outcomes.

Collaborate with pharmacists, physicians, and other healthcare professionals to optimize medication therapy management and patient outcomes.

Stay updated on changes in insurance regulations and prior authorization guidelines.

Qualifications:

High school diploma or equivalent required; Bachelor's degree preferred.

Minimum of 2 years of experience working as a Prior Authorization Specialist in a pharmacy or healthcare setting.

Strong knowledge of pharmacy operations, medication terminology, and insurance processes.

Familiarity with electronic health records (EHR) and pharmacy management systems.

Excellent communication and interpersonal skills.

Ability to work independently and collaboratively in a fast-paced environment.

Attention to detail and strong organizational skills.

Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

Preferred Qualifications:

Certification as a Pharmacy Technician (CPhT) or similar credential.

Experience working with prior authorization software systems.

Knowledge of Medicare, Medicaid, and commercial insurance plans.

Benefits:

Competitive salary commensurate with experience.

Paid time off and holiday pay.

Opportunities

Full-time