Pharmacy Prior Authorization Specialist

Onco360; Kentucky; Hybrid; USD 26,000 - 37,000; Full time

Benefits offered by this job

401k with a match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Quarterly Incentive Bonus

Referral Incentive Program

Company Paid Life Insurance; and Short

Job summary

Onco360 is seeking a Pharmacy Prior Authorization Specialist in Cleveland, OH to ensure patients receive medications requiring pre-authorizations. The role involves handling prescriptions, addressing rejected claims, and coordinating third-party authorization requests.

You will manage prior authorizations and appeals with insurance carriers, collaborate with physicians and pharmacies, maintain HIPAA compliance, and monitor renewals.

Qualifications

• High School Diploma or GED required.
• 1+ year of pharmacy or prior authorization experience.
• Pharmacy Technician license/registration as state law requires.
• Strong knowledge of pharmacy terminology and insurance claims.
• Experience with CoverMyMeds and NCPDP claim rejection resolution.

Responsibilities

• Manage prior authorization requests and appeals with insurance carriers.
• Collaborate with physicians, pharmacists, and other departments.
• Ensure HIPAA compliance while handling patient information.
• Maintain accurate documentation of authorization details.
• Proactively monitor and renew expiring authorizations.

Skills

Pharmacy/Prior authorization

NCPDP claim resolution

Medicare/Medicaid knowledge

Communication skills

HIPAA compliance

CoverMyMeds

Coordination of benefits

Education

High School Diploma or GED

Job description

Pharmacy Prior Authorization Specialist - Onco360 Pharmacy

Full-Time | Starting at $23.00/hr and up

Location: Cleveland, OH

Job Id:5528

# of Openings:1

Sign-On Bonus: $5,000 for employees starting before September 30, 2026!

As our company continues to grow, we strive to hire new team members with a passion for making a difference in our patient's lives.

Why Join Us?

• A career with purpose: Help patients access life-saving medications.
• Supportive culture: We valueteamwork, respect, integrity, and passion.
• Growth opportunities: We invest in your professional and personal development.

Company Benefits

• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Quarterly Incentive Bonus
• Referral Incentive Program
• Company Paid Life Insurance; and Short/Long-Term Disability

What You’ll Do

The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

How You’ll Do This

• Manage prior authorization requests and appeals with insurance carriers.
• Collaborate with physicians, pharmacists, and other departments.
• Ensure HIPAA compliance while handling sensitive patient information.
• Maintain accurate documentation of authorization details.
• Proactively monitor and renew expiring authorizations.

What You Bring

Required:

• High School Diploma or GED
• 1+ years of pharmacy or prior authorization experience
• Pharmacy Technician License/Registration with Board of Pharmacy (as required by state law)
• Strong communication, organizational, and customer service skills
• Self-motivated, organized, detail-oriented, and adaptable to changing priorities
• Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

Preferred:

• 3+ years of experience in pharmacy or prior authorizations
• Specialty pharmacy experience