Pharmacy Prior Authorization Specialist
About The Position
Infusion For Health provides infusion therapy to patients with autoimmune disorders and complex chronic conditions, emphasizing professional care, compassion, collaboration, and optimal treatment outcomes. The Pharmacy Prior Authorization Specialist helps secure timely insurance approvals for specialty and infusion medications by obtaining and submitting required documentation to support patient access to therapy. The role is suited to someone experienced in specialty or infusion pharmacy, insurance verification, and prior authorizations for high-cost medications. The specialist reviews new infusion referrals, coordinates benefits investigations, submits clinical documentation and forms to payers, follows up to resolve authorization delays, documents communication and authorization status, and maintains knowledge of payer-specific policies for infusion therapies.
Requirements
- At least 2 years of experience in infusion or pharmacy prior authorization.
- At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
- Organizational skills sufficient to maintain consistently accurate records.
- Intermediate-level skills in Microsoft Excel, Word, and Outlook.
- Experience with prior authorizations, insurance verification, and medication access workflows.
- Proficiency with electronic health records (EHRs), pharmacy benefit tools, and prior authorization portals such as CoverMyMeds.
- Experience collaborating with pharmacists, providers, and insurance companies.
Nice To Haves
- Certification as a Pharmacy Technician and/or an active Pharmacy Technician license.
Responsibilities
- Review new infusion referrals and coordinate benefits investigations for commercial and government payers.
- Obtain and submit required clinical documentation and forms to insurance companies for prior authorization requests.
- Follow up with payers, providers, and internal teams to resolve delays in the authorization process.
- Document communications and authorization statuses in pharmacy software or CRM systems.
- Maintain working knowledge of payer-specific policies for infusion therapies, including Medicare, Medicaid, and commercial plans.
- Collaborate with pharmacists, providers, and insurance companies to resolve access barriers and support patient adherence.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
