Pharmacy Prior Authorization Specialist
📍 Plano, TX (Fully Onsite)
💰 $21 – $28 per hour
🕒 Monday – Friday | 8:30 AM – 5:00 PM
About the Role
We are seeking a Pharmacy Prior Authorization Specialist to support complex specialty medication workflows and ensure timely access to therapy for patients. This role plays a critical part in managing prior authorization processes, coordinating with insurance payers, and collaborating with clinical and pharmacy teams.
The ideal candidate is detail-oriented, proactive, and comfortable navigating insurance systems while communicating with payers, patients, and healthcare professionals. Candidates with pharmacy or healthcare insurance experience who enjoy problem-solving and working in a fast-paced environment will thrive in this role.
Key Responsibilities
Prior Authorization & Benefits Coordination
- Contact insurance companies to obtain real-time status updates on prior authorization requests
- Run benefit investigations and gather documentation needed for commercial insurance authorizations
- Check status daily on pending authorizations and ensure timely follow-up
- Assist with continuation authorizations for existing patients
Documentation & Data Management
- Accurately enter approval letters, authorization numbers, and related documentation into internal systems such as CareTend
- Enter patient demographics, diagnosis information, and payor data into the electronic medical record
- Maintain detailed records of payer interactions including reference numbers and next steps
Denial Review & Workflow Management
- Review denial letters and ensure documentation is complete before routing cases to clinical teams for review and appeals
- Monitor authorization queues to prevent delays in patient therapy initiation or continuation
- Conduct patient chart audits and maintain current documentation files
Collaboration & Communication
- Coordinate with pharmacy operations, intake teams, clinical staff, and revenue cycle teams
- Communicate authorization outcomes and documentation needs to internal teams
- Maintain professional communication with insurance representatives, patients, and referral sources
Required Qualifications
- High School Diploma or GED
- 1+ year of experience in a pharmacy, healthcare, or medical insurance environment
- Experience with prior authorizations, benefits verification, or insurance coordination
- Strong attention to detail and data entry accuracy
- Ability to manage multiple tasks and changing priorities in a fast-paced environment
- Experience with Microsoft Office (Excel, Outlook, Word, Teams)
Preferred Qualifications
- Pharmacy Technician Certification (preferred but not required)
- Experience with CareTend or similar pharmacy/authorization platforms
- Knowledge of Medicare, Medicaid, and commercial insurance plans
- Experience in pharmacy billing, specialty pharmacy, or medical insurance verification
