Pharmacy Prior Authorization Specialist

Onco360 • Waltham, MA

5d • Hybrid

About The Position

Onco360 Pharmacy is hiring a full-time Pharmacy Prior Authorization Specialist in Waltham, Massachusetts. The role helps patients with cancer and rare diseases access medications by managing insurance pre-authorizations, addressing rejected claims, and submitting third-party authorization requests. The position is intended for candidates local to the area; remote work may be possible after initial on-site training.

The specialist manages authorization requests and appeals, collaborates with physicians, pharmacists, and other departments, handles sensitive patient information in compliance with HIPAA, documents authorization details accurately, and monitors authorizations for renewal.

Requirements

• High school diploma or GED.
• At least 1 year of pharmacy or prior authorization experience.
• Registration with the Board of Pharmacy, as required by state law.
• Strong communication, organizational, and customer service skills.
• Self-motivated, organized, detail-oriented, and adaptable to changing priorities.
• Knowledge of pharmacy terminology; pharmacy insurance claims; Medicare, Medicaid, and commercial insurance; pharmacy test claims and NCPDP claim rejection resolution; coordination of benefits; and NDC medication billing.
• Experience with CoverMyMeds.

Nice To Haves

• Associate degree or Certified Pharmacy Technician (PTCB).
• At least 3 years of experience in pharmacy or prior authorizations.
• Specialty pharmacy experience.

Responsibilities

• Manage prior authorization requests and appeals with insurance carriers.
• Collaborate with physicians, pharmacists, and other departments.
• Ensure HIPAA compliance while handling sensitive patient information.
• Maintain accurate documentation of authorization details.
• Proactively monitor and renew expiring authorizations.
• Receive prescriptions, address and rectify rejected claims, and conduct necessary third-party authorization requests.

Benefits

• Medical, dental, and vision coverage.
• 401(k) with a company match.
• Paid time off and paid holidays.
• Tuition reimbursement.
• Quarterly incentive bonus.
• Paid volunteer day.
• Referral incentive program.
• Company-paid life insurance.
• Short- and long-term disability coverage.
• $5,000 sign-on bonus for employees starting before December 28, 2026.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED