PSC, Medication Prior Authorization, Pharmacy

Job Description:

• Submit and manage prior authorization requests for medications only, as required by insurance carriers.
• Review physician medication orders, supporting clinical notes, and documentation to ensure prior authorization requests are complete and accurate.
• Track medication prior authorizations from submission through approval, denial, or request for additional information.
• Follow up with payers to ensure timely determinations and minimize delays in medication access.
• Coordinate prescription refills in collaboration with providers and pharmacies.
• Serve as the primary point of contact for pharmacies regarding medication-related questions, clarifications, and insurance requirements.
• Support enrollment and coordination of patient assistance programs for medications when applicable.
• Communicate with patients regarding medication-specific authorization requirements, timelines, approvals, denials, and next steps.
• Identify medication prior authorization denials and coordinate appeals when appropriate.
• Manage assigned work queues, tasks, and follow-ups to meet defined turnaround times.
• Maintain compliance with payer requirements, HIPAA, and organizational policies.

Requirements:

• Prior experience in prior authorization, insurance verification, or healthcare administration.
• Strong knowledge of insurance authorization processes and payer requirements.
• Excellent organizational and time-management skills.
• Strong written and verbal communication skills.
• Ability to work independently in a remote environment and manage multiple priorities.
• Preferred Experience working in a specialty practice or surgical setting.
• Familiarity with EMR systems and authorization portals.
• Experience with appeals and medical necessity documentation.
• Prior experience in a remote or centralized PSC role.

Benefits:

• PTO Accruals Start at 3 Weeks
• Comprehensive Medical and Dental Insurance
• Company Paid Optical Allowance
• Company Paid Routine Eye Care
• Short Term and Long-Term Disability Insurances
• Educational Allowance
• Generous Paid Holiday Program
• 401K With Company Match