Pharmacy Prior Authorization Specialist – Oncology (Remote)

Onco360; Waltham (MA); Hybrid; USD 26,000 - 37,000; Full time

Benefits offered by this job

Sign-on bonus

Remote work after training

Job summary

Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our Waltham team. This full-time role focuses on obtaining prior authorizations, addressing rejected claims, and coordinating with providers and insurance carriers.

The ideal candidate has 1+ year in pharmacy or prior authorizations, strong communication skills, and knowledge of Medicare/Medicaid and NCPDP claim processes. On-site with potential remote work after training.

Qualifications

• 1+ years of pharmacy or prior authorization experience.
• 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, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds

Responsibilities

• 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.

Skills

Communication skills

Organizational skills

Customer service

HIPAA compliance

Detail oriented

Adaptable

Pharmacy terminology

NCPDP claims

CoverMyMeds

Education

High School Diploma or GED

Tools

CoverMyMeds

Job description

Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our Waltham team. This full-time role focuses on obtaining prior authorizations, addressing rejected claims, and coordinating with providers and insurance carriers.

The ideal candidate has 1+ year in pharmacy or prior authorizations, strong communication skills, and knowledge of Medicare/Medicaid and NCPDP claim processes. On-site with potential remote work after training.