Senior Pharmacy Prior Authorization Representative

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Secure initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies through portal, phone, and fax.

• Proactively follow up on initial and renewal authorizations in a timely manner.

• Collaborate with other departments to identify medical documentation that supports prior authorization requests.

• Inform patients, prescribers, and internal teams regarding insurance denials and the appeals process.

• Verify plan eligibility and process test claims accordingly.

• Calculate necessary units and quantities in relation to day supply.

• Prioritize and complete assigned tasks within the designated schedule.

• Provide timely responses to chat and email update requests.

• Communicate problems, concerns, questions, and ideas through the appropriate channels.

• Maintain expected productivity levels and work efficiently.

• Adhere to quality standards, demonstrating reliability and follow-through.

• Communicate effectively and articulate ideas clearly.

• Operate in accordance with system-wide competencies and behaviors.

• Undertake additional duties as assigned.

⛳️ Requirements

• High School diploma or GED is mandatory.

• A minimum of 2 years of experience in prior authorization, insurance verification, or related fields within a physician practice, ancillary provider, or similar healthcare setting is required.

• Familiarity with medical terminology is essential.

• Understanding of payer websites, eligibility, and coordination of benefits is required.

• Knowledge of plan formularies and authorization requirements is necessary.

• Awareness of pharmacy versus medical payers and their authorization processes is required.

• Proficiency in computer skills and Microsoft Office products is essential.

• Computer literacy, including Windows and the MS Office Suite (Outlook, Word, and Excel), is required.

• For those working from home occasionally or permanently, a cable broadband or fiber optic internet connection with a minimum speed of 10Mbps download/5Mbps upload is necessary.

🏝️ Benefits

• Opportunity for remote work arrangement.

• Requirement for work-from-home internet service with minimum speeds of 10Mbps download/5Mbps upload.

• Tobacco-free policy and eligibility for smoking cessation programs where applicable.