Pharmacy Prior Authorization Specialist

Position: Pharmacy Prior Authorization Specialist

Location: Waltham, MA

Job Id: 4162

# of Openings: 1

Come join our company!
Our Onco360 Pharmacy has an immediate need for a full-time Pharmacy Prior Authorization Specialist in Waltham, Massachusetts.

We offer benefits including quarterly incentive bonuses and are seeking candidates who live locally to this pharmacy location.

Our mission is to better the lives of those battling cancer and rare diseases.
We value teamwork, respect, integrity, and passion, and foster an environment that supports professional and personal growth.

Starting at $23.00/hour and up, we offer a variety of benefits such as:

401(k) with a match Paid Time Off and Holidays Tuition Reimbursement Company-paid benefits including life, short and long-term disability The Pharmacy Prior Authorization Specialist will ensure patients receive medications requiring pre-authorizations by managing insurance claims, addressing rejections, and conducting third-party authorization requests.

Primary Responsibilities: Assist with medical necessity documentation to expedite approvals. Follow workflow and policies for prior authorizations. Collaborate with other departments to obtain prior authorizations. Review and ensure completeness of information and supporting documents. Monitor and process prior authorization requests. Consult with supervisors or pharmacists for treatment appropriateness. Manage correspondence with insurance, physicians, and patients. Appeal denials to obtain approvals. Document all authorization details accurately. Proactively manage expiring authorizations. Handle patient information with discretion and in compliance with HIPAA. Qualifications: Good interpersonal skills and customer service abilities. Ability to work independently and meet deadlines. Organized, detail-oriented, with knowledge of medical and pharmacy terminology. Licensed/registered pharmacy technician as per state law. Basic math and analytical skills. Education and Experience: Required: High School Diploma or GED, previous pharmacy and prior authorization experience. Desired: Associate degree, Certified Pharmacy Technician (PTCB), or specialty pharmacy experience. Work Experience: Required: 1+ years in pharmacy or prior authorization. Desired: 3+ years in pharmacy or prior authorization. Skills and Certifications: Experience with CoverMyMeds, pharmacy claims, Medicare, Medicaid, commercial insurance. Knowledge of pharmacy terminology, NDC billing, claim rejection resolution. Registration with the Board of Pharmacy as required. Excellent communication and time-management skills.
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