Prior Authorization Specialist

Prior Authorization Specialist

As a Remote Prior Authorization Specialist, you will play a crucial role in managing coverage determination requests and ensuring efficient communication between providers, members, and the pharmacy system. Your key duties will include:

• Monitoring and prioritizing coverage determination requests submitted by providers.
• Approving coverage determination requests based on defined criteria and entering decisions into the PBM system.
• Responding to client inquiries regarding authorization approvals and PBM online applications.
• Referring coverage determination requests for specialty drugs to delegated vendors or clients for processing.
• Contacting providers for additional information to facilitate coverage determination reviews.
• Maintaining accurate records of all coverage determination requests and decisions.
• Building a culture of care, engagement, and recognition with clear outcomes.

Hard Skills:

• Strong computer skills, including proficiency in Microsoft Suite.
• Attention to detail and excellent organizational skills.
• Strong communication and interpersonal skills.
• Ability to work independently in a remote setting.

Preferred Qualifications:

• Previous experience in a healthcare/pharmacy setting.
• Prior authorization experience.
• Familiarity with third-party claims processing.

Work Environment:

• This is a fully remote position.
• Must have a dedicated workspace with reliable high-speed internet.
• Scheduling including occasional weekends.

Pay and Benefits

The pay range for this position is $18.00 - $22.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

Application Deadline

This position is anticipated to close on Oct 17, 2025.