Prior Authorization Specialist

CareMed Specialty Pharmacy • Albuquerque, NM

13d • Hybrid

About The Position

CareMed Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training. This role is crucial in ensuring patients receive the medications that require pre-authorizations from insurance carriers. The specialist will manage the entire process from receiving prescriptions to addressing rejected claims and conducting necessary third-party authorization requests.

Requirements

• High School Diploma or GED
• 1+ years of pharmacy or prior authorization experience
• 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 and Paid Holidays
• Tuition Reimbursement
• Quarterly Incentive Bonus
• Paid Volunteer Day
• Referral Incentive Program
• Company Paid Life Insurance
• Short/Long-Term Disability
• Sign-On Bonus: $5,000 for employees starting before August 31, 2026

What This Job Offers

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