Pharmacy Prior Authorization Specialist

Job Description

Job Description

Infusion For Health is dedicated to serving patients with autoimmune disorders and complex chronic conditions through exceptional infusion therapy. Our mission is to provide a patient-focused environment that emphasizes professional care, compassion, and collaboration to ensure optimal treatment outcomes.

The Prior Authorization Pharmacy Technician plays a critical role in securing timely insurance approvals for specialty and infusion medications. This position ensures that all required documentation is obtained and submitted to payers to facilitate patient access to therapy. The ideal candidate will have experience working in a specialty or infusion pharmacy and a strong understanding of insurance verification and the prior authorization process for high-cost medications.

Key Responsibilities

• Demonstrated experience with prior authorizations (PAs), insurance verification, and medication access workflows
• Proficient in using electronic health records (EHRs), pharmacy benefit tools, and prior authorization portals (e.g., CoverMyMeds etc)
• Experience collaborating with pharmacists, providers, and insurance companies to resolve access barriers and support patient adherence
• Review new infusion referrals and coordinate benefits investigation for commercial and government payers.
• Obtain and submit all necessary clinical documentation and forms to insurance companies for prior authorization requests.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.
• Document all communication and authorization statuses in pharmacy software or CRM systems.
• Maintain working knowledge of payer-specific policies for infusion therapies, including Medicare, Medicaid, and commercial plans.

QUALIFICATIONS

• At least 2 years of experience in infusion or pharmacy prior authorization is required.
• At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
• Organizational skills are sufficient to maintain consistently accurate records.
• Intermediate level skills in Microsoft Excel , Word, and Microsoft Outlook, and
• Certification as a Pharmacy Technician and/or hold an active Pharmacy Technician license.