Pharmacy Prior Authorization Senior Representative - Freedom Fertility - Remote AZ or IL or MA
About The Position
The Pharmacy Prior Authorization Senior Representative is part of a specialized team supporting high-touch pharmacy programs for patients. The role focuses on researching pharmacy benefits, obtaining prior authorizations, processing prescription orders and claims, and communicating with internal sales teams, patients, providers, clinics, and pharmacies. Representatives work with a specific group of clinics and use internal and external pharmacy and clinic systems to complete prior authorizations and provide accurate, attentive service. The position requires detailed prescription and claim processing, investigation of benefit inquiries, prior authorization submissions and follow-up, and appeals when needed. Representatives help patients and providers understand pharmacy benefits, participate in program-specific customer meetings and training, and support special projects and contract performance. The role is remote in Arizona, Illinois, or Massachusetts, subject to the stated internet requirements for home-based work. The anticipated hourly rate is $19–$29, depending on relevant factors, and the position is anticipated to be eligible for an annual bonus plan.
Requirements
- High school diploma or GED.
- At least 2 years of Pharmacy Technician experience.
- Valid National Pharmacy Technician certification.
- Valid Arizona, Massachusetts, or Illinois state pharmacy technician license.
- Microsoft Office proficiency and data-entry skills.
- Strong math skills related to prescription calculations.
- Exceptional attention to detail, accuracy, and quality.
- Excellent verbal and written communication skills.
- Ability to multitask across computer- and phone-related tasks.
- At least 1 year of relevant experience submitting prior authorizations using CoverMyMeds or similar electronic prior authorization tools.
- Experience with prior authorization appeals and denials.
- Ability to work effectively and foster teamwork, take ownership of projects, and build strong relationships with colleagues and customers.
- Results-oriented approach, with the ability to prioritize workload, manage deadlines, and meet them.
- For home-based work, an internet connection through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download and 5 Mbps upload.
Nice To Haves
- Experience working with clinical EMR systems.
- Experience in infertility.
Responsibilities
- Enter prescriptions accurately, adjudicate claims, and resolve claim rejections so prescriptions can be dispensed accurately.
- Use clinic-specific electronic medical record systems to obtain information needed for prior authorization submissions.
- Follow program-specific contractual requirements and company practices.
- Investigate processing and benefit inquiries from the Fertility Inside Sales team rapidly and thoroughly.
- Conduct insurance inquiries and benefit checks.
- Submit prior authorizations, follow up, and prepare appeals as needed.
- Manage multiple tasks while maintaining attention to detail.
- Help patients and providers understand pharmacy benefits and answer their questions.
- Handle internal and external inquiries about prior authorizations using strong communication skills.
- Participate in program-specific customer meetings and training sessions.
- Participate in special projects and perform other duties related to specific contract performance.
Benefits
- Medical benefits
- Vision benefits
- Dental benefits
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Eligibility to participate in an annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
