Pharmacy Prior Authorization Specialist

TrueScripts Management Services, LLC; Henderson, Northern (NV, KY); Hybrid; USD 42,000 - 64,000; Full time

Job summary

TrueScripts Management Services, LLC is seeking a detail-oriented Prior Authorization Coordinator to review and process pharmacy PA requests from ePA, fax or provider/member requests. You will verify documents and obtain necessary records per pharmacist guidance.

You will become proficient in PA navigation software and handle submissions from receipt to clinical review determination, ensuring timely, accurate processing for members and providers in the Pacific time zone and beyond.

Qualifications

• High school diploma required; two-year degree preferred.
• Experience in pharmacy prior authorizations or retail pharmacy is a plus.
• Strong communication with members, offices, and pharmacies.

Responsibilities

• Complete new/renewal prior authorization requests for specialty and non-specialty drugs.
• Contact members, pharmacies, and physician offices by phone, email, and fax as needed.
• Ensure compliance with benefit plan parameters.
• Educate members on pharmacy benefit plans and prior authorizations.
• Monitor PA queues and process requests per guidelines.
• Investigate and resolve issues related to prior authorizations.
• Receive automated ePA and manual clinical reviews; send denial letters.
• Move approved PA to appropriate queues; perform other duties as assigned.

Skills

Microsoft Office 365

Effective communication

Multitasking

Independent work

Analytical thinking

Problem solving

Attention to detail

Team player

Education

High school diploma

Two-year degree in related field

Tools

PA navigation software

Job description

TrueScripts Management Services, LLC is seeking a detail-oriented Prior Authorization Coordinator to review and process pharmacy PA requests from ePA, fax or provider/member requests. You will verify documents and obtain necessary records per pharmacist guidance.

You will become proficient in PA navigation software and handle submissions from receipt to clinical review determination, ensuring timely, accurate processing for members and providers in the Pacific time zone and beyond.