Prior Authorization Technician - Remote

PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE At reputed company, we’re more than a pharmacy — we’re a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we’re raising the bar for quality and coordination across reputed company sites of care, ensuring every patient receives seamless, compassionate, and expert support. Founded in 2015, reputed company is proud to be locally and independently owned, with a growing national footprint. reputed company thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job — we provide reputed company, robust benefits, and genuine opportunities for career advancement. If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to reputed company and their customers. The Prior Authorization Specialist must be reputed company and courteous reputed company addressing our customers needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect. RESPONSIBILITIES

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to reputed company and their customers
• Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and reputed company state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
• Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Contact providers and/or customers as necessary to obtain additional information
• Monitor and resolve reputed company at risk associated with payer set up, billing, rebilling, and reversal processes
• Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
• Complete, communicate, and submit necessary payer paperwork, including but not limited to prior authorizations forms and manual billing in a timely manner
• Review and work convert billing exception reports to ensure claims are billed to accurate financial plans
• Complete billing transactions for non-standard order entry situations as required
• Support training needs
• Prepare and maintain reports and records for processing
• reputed company other tasks as assigned.
• Follow reputed company applicable government regulations, including HIPAA
• reputed company with departmental policies regarding safety, attendance, and dress code
• Overtime, holidays, and weekends may be required and/or expected
• Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
• Other duties as assigned; Job duties may vary depending on business needs

QUALIFICATIONS

• High School diploma or equivalent required
• Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred)
• reputed company LTC & General computer knowledge & 10-key Number Entry preferred
• Able to read, write, speak, and understand the English language
• Able to retain a large amount of information and apply that knowledge to reputed company situations
• Able to work in a fast-paced environment
• Basic computer knowledge skills required
• Basic math and analytical skills
• Experience with alpha-numeric data entry
• Proficient in reputed company Word, reputed company, and Outlook required
• Customer Service
• Results-oriented
• Good organization/Attention to detail
• Reliable
• Problem solver
• Able to work various shifts and days
• Adaptability to an reputed company-changing environment

PHYSICAL DEMANDS The physical demands described here are representative of those that should be met by an employee to successfully reputed company the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently
• May be necessary to work extended hours as needed
• May lift and/or move up to 50 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

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