Job Description

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

Job Tags

Similar Jobs