Pharmacy Insurance & Prior Authorization Specialist

Specialty Rx, INC.; Morton Grove (IL); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive pay based on experience

Health, dental, and vision insurance

401(k) with company match

Paid time off and holidays

Training and professional development

Career advancement opportunities

Job summary

SpecialtyRx, Inc. in Illinois is seeking a detail-oriented Prior Authorization & Insurance Billing Specialist to join our Long-Term Care Pharmacy Billing Department.

You will research insurance coverage, process prior authorizations, resolve rejections, and maintain accurate patient billing records. The ideal candidate has retail pharmacy billing experience, familiarity with state programs and Medicare Part D, and is comfortable communicating with insurers, client facilities, and internal teams

Qualifications

• High School Diploma or GED required.
• PTCB certification preferred or required depending on responsibilities.
• Retail pharmacy experience required.
• Experience with pharmacy insurance billing and prior authorizations preferred.
• Long-term care pharmacy experience preferred.
• Hospice billing experience is a plus.
• Familiarity with state programs, Medicare Part D, and pharmacy claim codes preferred.
• Strong attention to detail and communication skills.

Responsibilities

• Research and verify patient eligibility and insurance coverage with state and private payers.
• Submit and follow up on prior authorization requests for state plans and other payers.
• Review rejection reports, identify causes, and resolve them to ensure accurate billing.
• Process insurance rejections and claim issues to support timely reimbursement.
• Maintain patient billing and insurance records in the billing system.
• Communicate daily with insurers about authorizations, coverage changes, and eligibility updates.
• Coordinate with client facilities and program representatives to resolve billing issues.
• Assist hospice billing coordination and pricing inquiries as needed.
• Follow payer requirements, privacy standards, and internal policies.

Skills

Insurance billing research

Prior authorizations

Patient billing

Communication with insurers

Multi-tasking

Detail oriented

Education

High School Diploma or GED

PTCB Certification

Tools

Pharmacy Management System

Microsoft Office

Job description

SpecialtyRx, Inc. in Illinois is seeking a detail-oriented Prior Authorization & Insurance Billing Specialist to join our Long-Term Care Pharmacy Billing Department.

You will research insurance coverage, process prior authorizations, resolve rejections, and maintain accurate patient billing records. The ideal candidate has retail pharmacy billing experience, familiarity with state programs and Medicare Part D, and is comfortable communicating with insurers, client facilities, and internal teams