Job Title:
Prior Authorization Specialist
Location:
Fully Remote (Onsite option available in extenuating circumstances)
Employment Type:
W2 Contract
Contract Length:
12 months
Pay Range:
$22-25 per hour
Job Overview
We are hiring a Prior Authorization Specialist to provide support to pharmacists, physicians, and healthcare providers regarding Medicare Part D and Commercial pharmacy benefits. This role is responsible for analyzing prescription drug coverage, assisting with prior authorization requests, answering pharmacy benefit inquiries, and supporting claims adjudication processes. The ideal candidate will have pharmacy experience, strong customer service skills, and knowledge of prescription drug terminology and benefits.
Key Responsibilities
- Support providers with Medicare Part D and Commercial pharmacy benefit questions and coverage determinations.
- Review and process prior authorization requests in accordance with established guidelines.
- Respond to drug coverage inquiries and explain pharmacy benefit information.
- Analyze prescription claims and assist with claim adjudication issues.
- Research medication coverage, formulary status, and therapeutic alternatives.
- Maintain accurate documentation of provider interactions and case activity.
- Utilize Microsoft Office applications and internal systems to manage workflow and communications.
- Deliver exceptional customer service while handling a high volume of provider inquiries.
Required Qualifications
- High School Diploma or GED.
- Minimum 2 years of retail or hospital pharmacy experience.
- Experience with pharmacy claim adjudication.
- Knowledge of prescription drug names, therapeutic classes, and pharmacy terminology.
- Strong customer service and communication skills.
- Proficiency with Microsoft Office applications and computer systems.
- Understanding of basic drug classifications and medication therapies.
Preferred Qualifications
- Pharmacy Technician Certification (PTCB).
- Experience with Medicare Part D prescription benefits.
- Previous prior authorization or pharmacy benefit management experience.
- Associate degree or completion of two years of college coursework.