Pharmacy Prior Authorization Specialist

Infusion for Health; Riverside (CA); On-site; USD 30,000 - 40,000; Full time

Job summary

Infusion For Health in Riverside, CA is seeking a Pharmacy Prior Authorization Specialist to secure timely insurance approvals for specialty and infusion medications. The role focuses on obtaining and submitting documentation to payers to facilitate patient access to therapy.

The ideal candidate has at least two years of infusion or pharmacy PA experience, knowledge of Medicare/Medicaid guidelines, and proficiency with EHRs and payer portals; certification or license as a Pharmacy Technician is

Qualifications

• Minimum 2 years in infusion or pharmacy prior authorization.
• 2+ years with Medicare/Medicaid and managed care reimbursement.
• Strong organizational skills and accurate record keeping.
• Intermediate skills in Excel, Word, and Outlook.
• Pharmacy Technician Certification or active license.

Responsibilities

• Demonstrated experience with prior authorizations (PAs), insurance verification, and medication access workflows
• Proficient in using electronic health records (EHRs), pharmacy benefit tools, and prior authorization portals (e.g., CoverMyMeds)
• Experience collaborating with pharmacists, providers, and insurance companies to resolve access barriers and support patient adherence
• Review new infusion referrals and coordinate benefits investigation for commercial and government payers.
• Obtain and submit all necessary clinical documentation and forms to insurance companies for prior authorization requests.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.

Skills

Prior authorizations

Insurance verification

EHR systems

Payer portals

Collaboration

Education

Pharmacy Technician Certification

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Pharmacy Prior Authorization Specialist

Full Time Riverside, CA, US

4 days ago Requisition ID: 2336

Salary Range: $22.00 To $29.00 Hourly

Infusion For Health is dedicated to serving patients with autoimmune disorders and complex chronic conditions through exceptional infusion therapy. Our mission is to provide a patient-focused environment that emphasizes professional care, compassion, and collaboration to ensure optimal treatment outcomes.

The Prior Authorization Pharmacy Technician plays a critical role in securing timely insurance approvals for specialty and infusion medications. This position ensures that all required documentation is obtained and submitted to payers to facilitate patient access to therapy. The ideal candidate will have experience working in a specialty or infusion pharmacy and a strong understanding of insurance verification and the prior authorization process for high-cost medications.

Key Responsibilities

• Demonstrated experience with prior authorizations (PAs), insurance verification, and medication access workflows
• Proficient in using electronic health records (EHRs), pharmacy benefit tools, and prior authorization portals (e.g., CoverMyMeds etc)
• Experience collaborating with pharmacists, providers, and insurance companies to resolve access barriers and support patient adherence
• Review new infusion referrals and coordinate benefits investigation for commercial and government payers.
• Obtain and submit all necessary clinical documentation and forms to insurance companies for prior authorization requests.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.
• Document all communication and authorization statuses in pharmacy software or CRM systems.
• Maintain working knowledge of payer-specific policies for infusion therapies, including Medicare, Medicaid, and commercial plans.

QUALIFICATIONS

• At least 2 years of experience in infusion or pharmacy prior authorization is required.
• At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
• Organizational skills are sufficient to maintain consistently accurate records.
• Intermediate level skills in Microsoft Excel , Word, and Microsoft Outlook, and
• Certification as a Pharmacy Technician and/or hold an active Pharmacy Technician license.