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Pharmacy Authorization Specialist
Location
North America
Posted
1 day ago
Salary
0
Seniority
Senior
Job Description
Pharmacy Authorization Specialist
BRSi
• Coordinating prior authorizations, insurance verifications, medication approvals, and medical service approvals • Working closely with providers, pharmacies, insurance companies, and internal clinical or billing teams to obtain required approvals • Resolving authorization issues, and maintaining complete documentation • Frequent computer use, phone communication, insurance portal access, and coordination with multiple departments • This position typically reports to their Regional Manager, DOD Operations Manager, or Project Manager
Job Requirements
- High school diploma or equivalent required; associate degree in healthcare administration, medical billing, pharmacy technology, or a related field preferred
- Previous experience in prior authorization, pharmacy, medical billing, insurance verification, healthcare administration, or revenue cycle support preferred
- Knowledge of medical terminology, pharmacy terminology, insurance plans, prior authorization processes, and payer requirements
- Ability to read and interpret clinical documentation, prescription information, insurance guidelines, and authorization criteria
- Proficiency with electronic health records, pharmacy systems, insurance portals, practice management systems, and standard office software
- Strong written and verbal communication skills with the ability to interact professionally with patients, providers, pharmacies, and insurance representatives
- Experience working with Medicare, Medicaid, commercial insurance plans, specialty pharmacy authorizations, or pharmacy benefit managers preferred
- Familiarity with ICD-10, CPT, HCPCS, NDC numbers, formularies, quantity limits, and medical necessity criteria preferred
- Experience assisting with appeals, denied claims, specialty medication approvals, or high-volume authorization workflows preferred
Benefits
- Standard business hours are common, though schedules may vary based on organizational needs
- Comply with HIPAA, payer policies, organizational procedures, and applicable healthcare regulations
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