Pharmacy Prior Authorization Specialist

Onco360 • Pittsburgh, PA

1d • Hybrid

About The Position

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third-party authorization requests.

Requirements

• High School Diploma or GED
• 1+ years of pharmacy or prior authorization experience
• Pharmacy Technician License/Registration with 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 claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

Nice To Haves

• Associate degree or Certified Pharmacy Technician (PTCB)
• 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.

Benefits

• Medical
• Dental
• Vision
• 401k with a match
• Paid Time Off
• Paid Holidays
• Tuition Reimbursement
• Quarterly Incentive Bonus
• Paid Volunteer Day
• Referral Incentive Program
• Company Paid Life Insurance
• Short/Long-Term Disability

What This Job Offers

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