Job Title: Prior Authorization Specialist
Location: HYBRID in Detroit, MI
Job Type: W2 Contract
Expected hours per week: 40 hours per week
Schedule: 8am-5pm EST
Pay: $21 per hour (includes 1 week PTO and medical contribution to insurance – if desired)
Job Summary
This role supports a high?volume, fast?paced contact center environment responsible for processing mail and handling inquiries related to pharmacy benefits, coverage determinations, and medication review programs. The position requires accuracy, strong clinical knowledge, and the ability to meet strict turnaround times while delivering excellent service to members and healthcare providers. Occasional onsite work at the Detroit location is required on a rotational basis.
What You’ll Do
- Process inbound mail and requests related to medication review and authorization workflows.
- Respond to member and provider inquiries regarding pharmacy benefits, drug coverage, and determination requirements.
- Ensure all urgent and standard requests meet strict regulatory and internal timeframes (24 hours urgent, 72 hours standard).
- Work scheduled onsite rotations as required and adjust to schedule changes based on business needs.
- Maintain accurate documentation and comply with all procedures, quality standards, and performance expectations.
- Support peak?season workload (October–March), managing a high volume of inquiries efficiently.
What You Bring
Required Skills & Experience
- Minimum 2 years of retail pharmacy experience.
- Strong computer skills: typing, email, Outlook, Excel, and general navigation proficiency.
- Solid foundational knowledge of drug names, classifications, and therapeutic categories.
- Excellent customer service, attention to detail, and the ability to multitask in a dynamic setting.
- Adaptability and willingness to embrace process changes.
Work Hours
- Monday–Friday, typically starting at 8:30 AM and working as late as 5 PM during onsite days.
- Contact center hours: 8 AM–6 PM (shift flexibility required).
- Schedules assigned based on seniority and business needs.
What Makes You Stand Out (Preferred)
- Prior call center experience.
- Familiarity with CMS guidelines and Medicare Part D processes.
- Certified Pharmacy Technician (CPhT) credential.
Additional Details
- Hybrid role with required onsite rotation at the Detroit office location.
- Fast?paced, compliance?driven environment with strict timelines.
- Ideal for candidates who excel in structured, high?accuracy, member?support settings.
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