Pharmacy & Insurance Authorization Specialist

Urology San Antonio; San Antonio, Northern (TX, KY); Hybrid; USD 42,000 - 58,000; Full time

Job summary

Urology San Antonio is seeking an Insurance Authorization & Pharmacy Tech to verify insurance eligibility, obtain prior authorizations, and educate patients on costs. You will coordinate with physicians, pharmacies, and payers to ensure timely approvals and access to treatments.

The role requires at least one year in healthcare admin or related areas, strong organizational skills, and proficiency with EMR and payer portals. Experience with specialty meds and PBMs is a plus.

Qualifications

• Associate degree or equivalent required
• 1 year in healthcare admin/verification/prior authorizations/revenue cycle/pharmacy or related setting
• Proficient with EMR, payer portals, MS Office, and healthcare software
• Strong organization, communication and customer service skills
• Experience with medication prior authorizations, specialty pharmacy, infusion therapy, biologics, or medication assistance programs preferred
• Knowledge of Medicare/Medicaid/commercial insurance and PBM processes preferred
• Familiarity with specialty med reimbursement and assistance programs preferred

Responsibilities

• Verify insurance eligibility, benefits, coverage, referrals and authorizations before services
• Contact providers, patients, and payers to gather required information
• Review payer guidelines and policies for compliance
• Document verification findings in EMR and patient accounting systems
• Maintain accurate primary/secondary/tertiary insurance data
• Notify leadership of out-of-network issues and options for patients
• Maintain documentation of payer communications, approvals, denials, and status
• Obtain and manage prior authorizations for prescriptions and biologics
• Submit authorization requests through PBMs, specialty pharmacies, and payer systems
• Coordinate with providers to obtain clinical documentation for medical necessity
• Monitor and renew authorizations to prevent delays
• Assist with enrollment in patient assistance programs when applicable
• Educate patients on financial responsibilities and potential out-of-pocket costs
• Ensure CMS Conditions for Coverage compliance and patient notification requirements
• Maintain confidentiality per HIPAA and organizational policies

Skills

Healthcare admin

EMR systems

Payer portals

Microsoft Office

Communication

Customer service

Organizational skills

Education

Associate degree or equivalent

Tools

EMR software

Payer portals

Pharmacy software

Revenue cycle systems

Job description

Urology San Antonio is seeking an Insurance Authorization & Pharmacy Tech to verify insurance eligibility, obtain prior authorizations, and educate patients on costs. You will coordinate with physicians, pharmacies, and payers to ensure timely approvals and access to treatments.

The role requires at least one year in healthcare admin or related areas, strong organizational skills, and proficiency with EMR and payer portals. Experience with specialty meds and PBMs is a plus.