Pharmacy Prior Authorization Specialist

Onco360 • Waltham, MA

8h • Hybrid

About The Position

Onco360 Pharmacy is seeking a full-time Pharmacy Prior Authorization Specialist in Waltham, Massachusetts. The role ensures patients receive medications requiring insurance pre-authorization by receiving prescriptions, addressing and resolving rejected claims, and submitting necessary third-party authorization requests. The position is ideal for local candidates. Work may be remote after initial on-site training.

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.
• Knowledge of pharmacy test claims and NCPDP claim rejection resolution.
• Knowledge of 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 when handling sensitive patient information.
• Maintain accurate documentation of authorization details.
• Monitor authorizations proactively and renew them before they expire.
• Receive prescriptions, address and rectify rejected claims, and conduct necessary third-party authorization requests.

Benefits

• Medical, dental, and vision coverage.
• 401(k) with a 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