Prior Authorization Specialist (Remote)

Polaris Pharmacy Services•Fort Lauderdale, FL

3d•Remote

About The Position

The Prior Authorization Specialist manages a portfolio of rejected pharmacy claims to support maximum payer reimbursement, timely billing, and the reduction of financial risk for Polaris and its customers. The role researches and resolves claims with national Medicare Part D plans, third-party insurance companies, and state Medicaid plans, while meeting critical deadlines. It also involves completing and submitting prior authorization forms, communicating with providers and facility contacts, monitoring revenue risks, and helping identify and resolve payer and billing trends. The specialist is expected to provide responsive, courteous customer service and work effectively with colleagues and customers. The position supports training, maintains processing reports and records, follows applicable government regulations including HIPAA, and complies with company policies, procedures, and professional standards. Duties may vary according to business needs. Overtime, holidays, weekends, and schedule changes may be required or expected. This is a full-time remote position listed with Polaris Pharmacy Services of Ft. Lauderdale in Fort Lauderdale, Florida. The role may require sitting or standing for seven to ten hours per day, occasional climbing or balancing, stooping, kneeling, bending, and walking, and lifting or moving up to 30 pounds.

Requirements

High school diploma or equivalent.
Able to read, write, speak, and understand English.
Able to retain substantial information and apply it to related situations.
Able to work in a fast-paced environment.
Basic computer skills.
Basic math and analytical skills.
Experience with alphanumeric data entry.
Proficient in Microsoft Word, Excel, and Outlook.
Customer-service orientation and results-oriented approach.
Good organization and attention to detail.
Reliable and able to solve problems.
Able to work various shifts and days.
Adaptability to a changing environment.

Nice To Haves

One or more years of experience working as a pharmacy technician in a retail environment; long-term care pharmacy experience is preferred.
Knowledge of Framework LTC.
General computer knowledge and 10-key number-entry skills.

Responsibilities

Manage and identify rejected pharmacy claims to maximize payer reimbursement and ensure timely billing.
Research, analyze, and resolve rejected claims with Medicare Part D plans, third-party insurers, and state Medicaid plans, while meeting deadlines.
Perform appropriate edits and reversals to obtain claim approvals and maximize reimbursement.
Contact providers and facility contacts to obtain additional information as needed.
Monitor and resolve revenue at risk related to payer setup, billing, rebilling, and reversals.
Work with the team to identify, document, communicate, and resolve payer and billing trends and issues.
Complete, communicate, and submit prior authorization forms in a timely manner.
Support training needs.
Prepare and maintain processing reports and records.
Follow applicable government regulations, including HIPAA, and comply with departmental safety, attendance, and dress-code policies.
Conduct job responsibilities in accordance with the company’s Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable laws, and professional standards.
Perform other tasks as assigned, with duties potentially varying according to business needs.