Job Description

Pharmacy Prior Authorization Specialist

📍 Plano, TX (Fully Onsite)

💰 $21 – $28 per hour

🕒 Monday – Friday | 8:30 AM – 5:00 PM

About the Role

We are seeking a Pharmacy Prior Authorization Specialist to support complex specialty medication workflows and ensure timely access to therapy for patients. This role plays a critical part in managing prior authorization processes, coordinating with insurance payers, and collaborating with clinical and pharmacy teams.

The ideal candidate is detail-oriented, proactive, and comfortable navigating insurance systems while communicating with payers, patients, and healthcare professionals. Candidates with pharmacy or healthcare insurance experience who enjoy problem-solving and working in a fast-paced environment will thrive in this role.

Key Responsibilities

Prior Authorization & Benefits Coordination

• Contact insurance companies to obtain real-time status updates on prior authorization requests
• Run benefit investigations and gather documentation needed for commercial insurance authorizations
• Check status daily on pending authorizations and ensure timely follow-up
• Assist with continuation authorizations for existing patients

Documentation & Data Management

• Accurately enter approval letters, authorization numbers, and related documentation into internal systems such as CareTend
• Enter patient demographics, diagnosis information, and payor data into the electronic medical record
• Maintain detailed records of payer interactions including reference numbers and next steps

Denial Review & Workflow Management

• Review denial letters and ensure documentation is complete before routing cases to clinical teams for review and appeals
• Monitor authorization queues to prevent delays in patient therapy initiation or continuation
• Conduct patient chart audits and maintain current documentation files

Collaboration & Communication

• Coordinate with pharmacy operations, intake teams, clinical staff, and revenue cycle teams
• Communicate authorization outcomes and documentation needs to internal teams
• Maintain professional communication with insurance representatives, patients, and referral sources

Required Qualifications

• High School Diploma or GED
• 1+ year of experience in a pharmacy, healthcare, or medical insurance environment
• Experience with prior authorizations, benefits verification, or insurance coordination
• Strong attention to detail and data entry accuracy
• Ability to manage multiple tasks and changing priorities in a fast-paced environment
• Experience with Microsoft Office (Excel, Outlook, Word, Teams)

Preferred Qualifications

• Pharmacy Technician Certification (preferred but not required)
• Experience with CareTend or similar pharmacy/authorization platforms
• Knowledge of Medicare, Medicaid, and commercial insurance plans
• Experience in pharmacy billing, specialty pharmacy, or medical insurance verification

Job Tags

Similar Jobs