Prior Authorization Specialist

Job Description

Job Description

Prior Authorization Specialist

Full-Time | On-Site | Ashland, PA

Concept Billing Solutions is seeking a detail-oriented and organized  Prior Authorization Specialist to join our growing team in Ashland, PA.

In this role, you will help ensure patients receive timely access to prescription medications by managing prior authorizations from initial request through approval. Supporting a  long-term care (LTC) pharmacy environment , you’ll work closely with physician offices, nursing facilities, insurance companies, pharmacy teams, and other healthcare professionals to obtain approvals, resolve coverage issues, and keep authorizations moving forward.

This is an excellent opportunity for someone with experience in  prior authorizations, pharmacy insurance, insurance billing, or pharmacy claims who enjoys problem-solving, communicating with multiple parties, and working in a fast-paced healthcare environment.

• Complete and submit prior authorization requests for prescription medications accurately and on time.

• Review insurance and payer requirements to determine the documentation needed for authorization.

• Follow up consistently on pending prior authorizations and monitor requests through resolution.

• Coordinate appeals and additional documentation when authorization requests are denied or require further review.

• Investigate and resolve pharmacy claim rejections related to prior authorization requirements.

• Verify that authorization information and supporting documentation are complete and accurate.

• Maintain detailed, up-to-date records of authorization activity and outcomes.

• Meet established turnaround times and proactively address requests requiring urgent attention.

• Communicate professionally with physician offices, nursing facilities, insurance companies, pharmacy staff, and other healthcare partners.

• Obtain necessary clinical and insurance information to complete authorization requests.

• Follow up with providers and facilities when additional documentation or action is required.

• Work collaboratively with pharmacists, billing staff, and customer service teams to resolve insurance and medication-access issues.

• Keep appropriate parties informed of authorization status, outstanding requirements, and coverage issues.

• Take ownership of open requests and follow through until they are resolved.

• Experience with  prior authorizations, insurance billing, pharmacy claims, or related healthcare insurance processes is preferred.

• Pharmacy or  long-term care (LTC) pharmacy experience is a plus.

• Familiarity with Medicare, Medicaid, commercial insurance, or prescription drug coverage is a plus.

• Experience resolving insurance claim rejections, coverage issues, or authorization denials is helpful.

• Strong organizational skills and exceptional attention to detail.

• Ability to manage multiple authorization requests, deadlines, and priorities simultaneously.

• Strong follow-through and a commitment to seeing requests through resolution.

• Excellent written and verbal communication skills.

• Professional communication with healthcare providers, nursing facilities, insurance representatives, and pharmacy teams.

• Strong problem-solving skills and the ability to research and resolve insurance-related issues.

• Ability to work independently while managing multiple priorities.

• Comfortable learning and working across multiple computer systems.

• Proficiency with Microsoft Office.

Concept Billing Solutions offers a supportive team environment and a comprehensive benefits package, including:

• Medical insurance

• Paid vacation

• Paid holidays

• 401(k) retirement plan

• Employment type: Full-time

• Work arrangement: On-site

• Location: 600 Centre St, Ashland, PA 17921

• Company website:   conceptbillingsolutions.com

Concept Billing Solutions is a growing medical billing and revenue cycle management (RCM) company serving healthcare organizations nationwide.

We partner with healthcare providers across a wide range of specialties, providing services that include medical billing, coding, credentialing, prior authorization, benefits verification, and patient billing. Our team combines experienced professionals, advanced technology, and HIPAA-compliant systems to help our clients streamline operations, improve revenue performance, and focus on patient care.

At Concept Billing Solutions, we value  accuracy, responsiveness, follow-through, and genuine care for our clients' success . We're looking for professionals who share those values and want to make an impact as part of a growing healthcare services team.

If you're detail-oriented, comfortable navigating insurance requirements, and enjoy solving problems that help patients receive the medications they need, we'd like to hear from you.

Apply today to join the Concept Billing Solutions team as a Prior Authorization Specialist.

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