Prior Authorization Specialist - Pharmacy

The Insurance Support Specialist will support the Prior Authorization team, with a primary focus on pharmacy-related authorizations. The role requires prior hands-on experience in Prior Authorization, particularly within pharmacy, medication, or specialty drug workflows, and the ability to independently manage payer requirements and insurance guidelines. The position requires confidence working within the Prior Authorization function, a solid understanding of pharmacy-driven insurance processes, and a commitment to ongoing learning and professional development within a collaborative healthcare environment.

Responsibilities:
● Review patient records and gather necessary clinical documentation
● Contact insurance companies via online portal or phone to initiate the authorization process
● Provide insurance representatives with required details, including medical records, orders, labs, and scans as needed
● Contact referring provider offices to obtain missing clinical or additional information required for authorization
● Submit prior authorization requests via portal, fax, or phone (portal preferred) with all required documentation according to payer criteria
● Document insurance contact details, including representative name and reference numbers, in patient logs
● Record authorization details, including duration and approval numbers, upon receipt
● Notify the intake team promptly when pressing authorizations are completed
● Track prior authorization requests and take timely action to resolve denials
● Update process documentation when payor policy requirements change
● Add prior approval requirements for new medications to the company medication reference list
● Perform other ad hoc duties as assigned by the client's leadership team

Requirements:
● US Healthcare industry experience minimum 3-5 years.
● LPN, CNA, or RN & Pharm-D certification preferred
● Understanding of health insurance processes and patient care impact
● Strong interpersonal and communication skills
● Team-oriented approach with the ability to support business growth
● Ability to multitask and perform effectively under pressure
● Attention to detail and strong organizational skills

Note: Only shortlisted candidates be contacted.

Experience:

• pharmacy-related authorizations: 1 year (Required)

Work Location: Remote

Work Location: Remote