Prior Authorization Specialist / Remote

Job Description

Job Description

Overview

This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process.

Shift : Monday-Friday 8:30am-5:30pm (MST or PST)

What We Offer:

• DailyPay
• Flexible Schedules
• Competitive Pay with Shift Differentials
• Health, Dental, Vision, and Life Insurance
• Company-Paid Disability Insurance
• Tuition Assistance & Reimbursement
• Employee Discount Program
• 401k Plan
• Paid Time Off
• Non-Retail, Closed-Door Environment

Responsibilities

• Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines.
• Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions.
• Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols.
• Knowledgeable to perform all PA functions.

Qualifications

• High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy
• 1+ years pharmacy experience
• Pharmacy or healthcare-related knowledge
• Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication
• Basic math and analytical skills
• Intermediate typing/keyboard skills