Pharmacy Prior Authorization Specialist

Job summary

The Pharmacy Prior Authorization Specialist manages prior authorization requests and appeals with insurance carriers to ensure patients receive necessary medications. They also collaborate with healthcare professionals and maintain accurate documentation while ensuring HIPAA compliance.

Job details

Pharmacy Prior Authorization Specialist – Onco360 Pharmacy Denver, CO | Full-Time | Starting at $23.00/hr and up Sign-On Bonus: $5,000 for employees starting before September 30, 2026! Join a mission-driven team making a difference in the lives of cancer patients. Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in the State of Colorado. This is a full-time position. Remote work if licensed in State of Colorado. ---------------------------------------- Why Join Us? * A career with purpose: Help patients access life-saving medications. * Supportive culture: We value teamwork, respect, integrity, and passion. * Growth opportunities: We invest in your professional and personal development. Company Benefits * Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Tuition Reimbursement * Quarterly Incentive Bonus * Paid Volunteer Day * Referral Incentive Program * Company Paid Life Insurance; and Short/Long-Term Disability ---------------------------------------- What You’ll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests. How You’ll Do This * Manage prior authorization requests and appeals with insurance carriers. * Collaborate with physicians, pharmacists, and other departments. * Ensure HIPAA compliance while handling sensitive patient information. * Maintain accurate documentation of authorization details. * Proactively monitor and renew expiring authorizations. ---------------------------------------- What You Bring Required: * High School Diploma or GED * 1+ years of pharmacy or prior authorization experience * Registration with Board of Pharmacy (as required by state law) * Strong communication, organizational, and customer service skills * Self-motivated, organized, detail-oriented, and adaptable to changing priorities * Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds Preferred: * Associate degree or Certified Pharmacy Technician (PTCB) * 3+ years of experience in pharmacy or prior authorizations * Specialty pharmacy experience ---------------------------------------- Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer. Company Values: Teamwork, Respect, Integrity, Passion

What you’ll do

The Pharmacy Prior Authorization Specialist manages prior authorization requests and appeals with insurance carriers to ensure patients receive necessary medications. They also collaborate with healthcare professionals and maintain accurate documentation while ensuring HIPAA compliance.

Requirements

Candidates must have a High School Diploma or GED and at least one year of pharmacy or prior authorization experience. Registration with the Board of Pharmacy is required, and knowledge of insurance billing and pharmacy terminology is essential.

Benefits

• Medical • Dental • Vision • 401k with a match • Paid Time Off • Paid Holidays • Tuition Reimbursement • Quarterly Incentive Bonus • Paid Volunteer Day • Referral Incentive Program • Company Paid Life Insurance • Short-Term Disability • Long-Term Disability • Sign-On Bonus

Listed skills

• Customer service · Preferred
• Attention to detail · Preferred
• Communication Skills · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Prior authorization
• Pharmacy terminology
• Insurance claims
• Medicare
• Medicaid
• Commercial insurance
• NCPDP claim rejection resolution
• Coordination of benefits
• NDC medication billing
• CoverMyMeds
• HIPAA compliance
• Communication skills
• Organizational skills
• Customer service
• Attention to detail
• Time Off Management
• Pharmacy Experience
• Self-Motivation
• Billing
• Certified Pharmacy Technician
• Customer Service
• Communication
• Medical Prescription
• Prior Authorization
• Registration
• Coordinating
• National Drug Code (NDC)
• Teamwork
• Detail Oriented

Job areas

• Healthcare
• Administrative
• Customer Service & Support
• Prior Authorization Pharmacy Technician
• Medical Claims Processor / Representative
• Debt Collectors and Related Workers
• Correspondence Clerks