Pharmacy Prior Authorization Billing Technician

SpecialtyRx•Morton Grove, IL

22h

About The Position

SpecialtyRx, a long-term care pharmacy serving long-term care facilities, assisted living communities, and hospice providers, is seeking a detail-oriented and organized technician for its Illinois Long-Term Care Pharmacy Billing Department. The role researches insurance coverage, processes prior authorizations, resolves insurance rejections, and maintains accurate patient billing information. It involves frequent communication with insurers, client facilities, government program representatives, and internal departments in a fast-paced, deadline-driven environment. Pharmacy insurance billing, prior authorization, and eligibility research experience are relevant; long-term care pharmacy experience is preferred, and hospice billing or insurance coordination is a plus.

Requirements

High school diploma or GED required.
Previous retail pharmacy experience required.
PTCB certification is preferred or may be required depending on the position's responsibilities and applicable requirements.
Understanding of insurance overrides, coverage restrictions, and prior authorization processes.
Basic proficiency in Microsoft Office and pharmacy management or billing systems.
Strong attention to detail and ability to research, analyze, and resolve billing discrepancies.
Excellent telephone etiquette and professional communication skills.
Strong organizational and time-management skills, including ability to manage multiple priorities and deadlines.
Ability to work independently and collaborate effectively with a team.
Ability to work nights and weekends as required by departmental scheduling.
Dependable and proactive, with commitment to maintaining accurate patient and billing records.

Nice To Haves

Experience with pharmacy insurance billing, prior authorizations, and insurance eligibility research.
Long-term care pharmacy experience.
Experience with New York pharmacy billing claims.
Hospice billing or hospice medication coverage experience.
Familiarity with state insurance programs, private insurance plans, Medicare Part D, and pharmacy claim rejection codes.

Responsibilities

Perform duties and additional tasks as assigned by the Billing Supervisor.
Research and verify patient eligibility and insurance coverage through state-sponsored and private insurance providers.
Submit and follow up on prior authorization requests for state insurance plans and other applicable payers.
Review daily insurance rejection reports, identify causes, and take appropriate action to resolve rejections.
Research and process insurance rejections, overrides, and claim issues to support timely and accurate prescription billing.
Maintain and update patient billing information, insurance details, and eligibility records in the pharmacy management system.
Communicate with insurance companies regarding prior authorizations, overrides, rejected claims, coverage changes, and eligibility updates.
Coordinate with client facility staff and applicable insurance and government program representatives to resolve billing and coverage issues.
Assist with insurance research and billing coordination for hospice patients, including verifying coverage and helping resolve payer-related issues.
Assist client facilities with medication pricing inquiries and provide accurate price quotes when requested.
Follow up on pending prior authorizations, rejected claims, and unresolved billing issues to ensure timely resolution.
Perform monthly patient census reviews and reconcile patient information to support accurate billing.
Maintain accurate documentation of insurance research, authorization submissions, claim follow-ups, and billing communications.
Collaborate with pharmacy operations, billing, and other internal teams to support continuity of service and accurate reimbursement.
Follow established billing procedures, applicable payer requirements, privacy standards, and pharmacy policies.
Perform other duties as assigned by management.