Pharmacy Access & Prior Authorization Specialist

Whole Family Health Center Inc; Town of Florida (NY); On-site; USD 48,000 - 72,000; Full time

Job summary

Whole Family Health Center Inc in Fort Pierce, FL is seeking a Pharmacy Prior Authorization Specialist to manage prior authorizations for medications, coordinating with providers and insurance plans to secure timely approvals for in-house and external pharmacies.

The role requires strong knowledge of medical terminology, prescription medications, and insurance billing processes, with attention to HIPAA compliance and effective communication with patients and staff.

Qualifications

• High school diploma or GED required.
• Proficiency in pharmacy management systems, EMR, MS Office, and electronic billing.
• 2–5 years in a health center, retail or hospital pharmacy preferred.
• Knowledge of 340B pricing preferred.
• Experience with third-party billing and prior authorizations preferred.

Responsibilities

• Manage prescription prior authorizations for clinic patients at in-house and external pharmacies.
• Work with providers to obtain clinical documentation for prior authorizations.
• Review formulary requirements and suggest alternatives to providers.
• Monitor insurance rejection queues and resolve billing issues related to prior authorizations.
• Coordinate prescription transfers between providers and patients when appropriate.
• Communicate authorization status and requirements to patients and staff.
• Provide phone support for pharmacy operations as needed.
• Assist pharmacy leadership with operational duties.

Skills

Communication skills

Attention to detail

Problem solving

Spanish/Creole language skills

Education

High school diploma or GED

Tools

Pharmacy management systems

EMR systems

Microsoft Office

Electronic billing platforms

Job description

Whole Family Health Center Inc in Fort Pierce, FL is seeking a Pharmacy Prior Authorization Specialist to manage prior authorizations for medications, coordinating with providers and insurance plans to secure timely approvals for in-house and external pharmacies.

The role requires strong knowledge of medical terminology, prescription medications, and insurance billing processes, with attention to HIPAA compliance and effective communication with patients and staff.