Prior Authorization Specialist / Remote
Job Overview
This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process.
Shift: Monday-Friday 8:30am-5:30pm (MST or PST)
What We Offer:
- DailyPay
- Flexible Schedules
- Competitive Pay with Shift Differentials
- Health, Dental, Vision, and Life Insurance
- Company-Paid Disability Insurance
- Tuition Assistance & Reimbursement
- Employee Discount Program
- 401k Plan
- Paid Time Off
- Non-Retail, Closed-Door Environment
Responsibilities
- Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines.
- Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions.
- Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols.
- Knowledgeable to perform all PA functions.
Qualifications
- High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy
- 1+ years pharmacy experience
- Pharmacy or healthcare-related knowledge
- Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication
- Basic math and analytical skills
- Intermediate typing/keyboard skills
Additional Job Information
Percentage of Travel: 0-25% |
About Us
Notice of Use of Artificial Intelligence Tools in the Recruitment Process
At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing—leading with integrity, accountability, and transparency in all that we do. As part of this commitment, we share that we may use third-party artificial intelligence (AI) to process employment data in connection with our hiring processes. Any AI tool that we use always has humans in the loop; we do not use AI to automate employment decisions or to discriminate, and we do not use zip codes as proxy. Humans – our hiring leaders and recruiter – make final decisions. BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities; if you would like to request a reasonable accommodation, please contact your recruiter or send an inquiry to TalentAcquisition@brightspringhealth.com. For more information about how our company uses AI in the hiring process, contact TalentAcquisition@brightspringhealth.com.
BrightSpring is an Equal Opportunity Employer.
BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
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