Prior Authorization Specialist

Job Summary

Working remotely, the full-time Specialist I, Prior Authorization will review, process, and troubleshoot incoming Prior Authorization requests for medications, ensuring compliance with regulatory and client-specific guidelines.

Key responsibilities

• Research and analyze electronic and manual claims to resolve issues related to prior authorization requests
• Communicate prior authorization criteria to providers and assist them in submitting requests
• Maintain knowledge of Medicare D, Medicaid, and Exchange programs while participating in departmental projects

Required qualifications

• High school degree or equivalent; post high school education such as L.P.N. or Certified Pharmacy Technician preferred
• Previous customer service experience required
• Experience in health insurance/pharmacy insurance or managed care organization preferred
• Prior authorization processing experience desired
• Experience with Medicare and/or Medicaid regulatory guidance preferred