Pharmacy Authorization Specialist

This is a fully remote position, open to applicants in North America.

📋 Description

• Overseeing prior authorizations, insurance verifications, medication approvals, and approvals for medical services.

• Collaborating closely with providers, pharmacies, insurance companies, and internal clinical or billing teams to secure necessary approvals.

• Addressing authorization issues and ensuring thorough documentation is maintained.

• Engaging in frequent computer usage, phone communications, accessing insurance portals, and coordinating with various departments.

• This role typically reports to the Regional Manager, DOD Operations Manager, or Project Manager.

⛳️ Requirements

• A high school diploma or equivalent is required; an associate degree in healthcare administration, medical billing, pharmacy technology, or a related field is preferred.

• Prior experience in prior authorization, pharmacy, medical billing, insurance verification, healthcare administration, or revenue cycle support is preferred.

• Familiarity with medical terminology, pharmacy terminology, insurance plans, prior authorization processes, and payer requirements.

• Capability to read and interpret clinical documentation, prescription information, insurance guidelines, and authorization criteria.

• Proficiency in electronic health records, pharmacy systems, insurance portals, practice management systems, and standard office software.

• Excellent written and verbal communication skills, with the ability to interact professionally with patients, providers, pharmacies, and insurance representatives.

• Experience with Medicare, Medicaid, commercial insurance plans, specialty pharmacy authorizations, or pharmacy benefit managers is preferred.

• Knowledge of ICD-10, CPT, HCPCS, NDC numbers, formularies, quantity limits, and medical necessity criteria is preferred.

• Prior experience assisting with appeals, denied claims, specialty medication approvals, or high-volume authorization workflows is preferred.

🏝️ Benefits

• Standard business hours are typical, although schedules may vary depending on organizational needs.

• Adherence to HIPAA, payer policies, organizational procedures, and applicable healthcare regulations.