Prior Authorization Pharmacy Specialist I

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

📋 Description

• Conduct prior authorizations and appeals for oral oncology and supportive medications.

• Engage with patients, caregivers, and healthcare providers regarding inquiries about prescription statuses.

• Support pharmacy staff and healthcare professionals in the processing of prescriptions.

• Exhibit effective communication and deliver excellent customer service to both internal and external stakeholders.

• Carry out clinical chart reviews utilizing appropriate criteria to finalize prior authorizations.

• Manage appeals for prior authorization denials in accordance with insurance plan specifications.

• Prepare documentation and draft letters of medical necessity when required.

• Secure approvals through online authorization platforms, fax, and telephone communications.

• Analyze or deviate from standard clinical data procedures as necessary.

• Refer complex clinical issues to the relevant clinician.

• Adhere to accreditation standards, legal regulations, and company policies.

• Engage in the pharmacy’s Continuous Quality Improvement program by identifying and reporting quality-related incidents.

• Undertake additional tasks that support the team and FCS.

⛳️ Requirements

• High school diploma or GED is mandatory.

• Active Registered Florida Pharmacy Technician license and state residency is required.

• Active National Pharmacy Technician Certification is essential.

• Prior Authorization Certified Specialist (PACS) certification is preferred.

• A minimum of three (3) years of experience in a healthcare or customer service-related field, ideally in pharmacy or a call center.

• Experience with pharmacy benefit prior authorizations is preferred.

• Background in hematology/oncology is advantageous.

• Strong verbal and written communication skills.

• Excellent interpersonal abilities.

• Effective time management skills and capability to prioritize multiple tasks.

• Ability to collaborate with various management levels, departments, and teams.

• Proficiency in negotiating issues and exploring solutions with the physician population.

• Compliance with patient privacy laws and regulations, as well as company policies.

• Successful completion of background screening and drug testing.

• Ability to comply with vaccination requirements unless an exemption is approved.

🏝️ Benefits

• Significant professional opportunities.

• Career advancement prospects.

• Comprehensive training.

• Competitive salary.

• Tuition reimbursement options.

• 401-K matching program.

• Pet insurance availability.

• Legal insurance coverage.

• Influenza vaccination requirement, unless an approved exemption is in place.

• Background screening and drug testing are prerequisites for employment.