What are the responsibilities and job description for the Prior Authorization Specialist position at ALLIED PHARMACY?
Job Summary
We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our Specialty Pharmacy team in Houston. The ideal candidate will have a strong background in pharmacy billing, prior authorization processes, and insurance verification. This role requires effective communication with healthcare providers, patients, and insurance companies to ensure timely approval and processing of specialty prescriptions.
Key Responsibilities
- Process and manage prior authorization requests for specialty medications in compliance with payer requirements.
- Communicate with prescribers, patients, and insurance providers to obtain necessary documentation.
- Review insurance rejections, identify causes, and take corrective actions to resolve claim issues.
- Verify patient insurance coverage and determine benefit eligibility for prescribed therapies.
- Collaborate with pharmacists, technicians, and clinical staff to ensure smooth workflow in medication fulfillment.
- Stay updated on payer policies, formulary changes, and reimbursement guidelines.
- Maintain accurate patient and insurance records within pharmacy management systems.
- Assist in staff training regarding PA procedures and billing best practices when necessary.
Qualifications
- Minimum 2 years of prior authorization experience in a pharmacy or specialty pharmacy environment.
- At least 3 years of pharmacy billing experience, with a strong understanding of third-party payer systems.
- Deep understanding of pharmacy workflow, from prescription intake to claim submission and adjudication.
- Proficient in resolving insurance rejections and determining next steps efficiently.
- Excellent verbal and written communication skills; able to coordinate with physicians and insurance representatives effectively.
- Strong organizational and multitasking abilities in a fast-paced environment.
- High school diploma or equivalent required; Pharmacy Technician Certification (CPhT) preferred.
Preferred Skills
- Experience working with specialty medications (oncology, rheumatology, neurology, etc.).
- Familiarity with electronic medical record (EMR) systems and pharmacy management software.
- Knowledge of current reimbursement trends and insurance guidelines.
Pay: $17.00 - $21.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
Work Location: In person
Salary : $17 - $21