Prior Authorization Specialist

Job Description

Job Description

Position Overview: We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team. The ideal candidate will have a strong background in pharmacy operations, prior authorization processes, and excellent communication skills. As a Prior Authorization Specialist, you will play a critical role in ensuring that patients receive timely approvals for medications, navigating insurance requirements, and collaborating with healthcare providers to optimize patient care.

Responsibilities:

• Review prior authorization requests for medications to ensure completeness and accuracy.
• Communicate with healthcare providers, insurance companies, and patients to gather necessary information for prior authorization submissions.
• Verify insurance coverage and determine prior authorization requirements.
• Complete and submit prior authorization forms according to insurance guidelines and requirements.
• Follow up on prior authorization requests to ensure timely approvals and resolution of any issues or denials.
• Maintain accurate documentation of prior authorization activities and outcomes.
• Collaborate with pharmacists, physicians, and other healthcare professionals to optimize medication therapy management and patient outcomes.
• Stay updated on changes in insurance regulations and prior authorization guidelines.

Qualifications:

• High school diploma or equivalent required; Bachelor's degree preferred.
• Minimum of 2 years of experience working as a Prior Authorization Specialist in a pharmacy or healthcare setting.
• Strong knowledge of pharmacy operations, medication terminology, and insurance processes.
• Familiarity with electronic health records (EHR) and pharmacy management systems.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Attention to detail and strong organizational skills.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

Preferred Qualifications:

• Certification as a Pharmacy Technician (CPhT) or similar credential.
• Experience working with prior authorization software systems.
• Knowledge of Medicare, Medicaid, and commercial insurance plans.

Benefits:

• Competitive salary commensurate with experience.
• Paid time off and holiday pay.
• Opportunities