Prior Authorization & Appeals Specialist - Specialty Pharmacy

Amber Specialty Pharmacy; United States; On-site; USD 26,000 - 28,000; Full time

Benefits offered by this job

Paid holidays

No weekends

Job summary

Amber Specialty Pharmacy is seeking an Authorization Management Specialist to prepare appeal summaries and prior authorizations, communicating with prescribers and documenting in the EMR. The role requires knowledge of insurance verification and prescription adjudication, with HIPAA compliance and a high attention to detail.

The position is in the Operations department, reports to the Authorization Management Specialist, Lead, and involves coordinating with providers, health plans, PBMs, and

Qualifications

• Healthcare industry knowledge or familiarity
• HIPAA training or ability to work with confidential information
• Six months or less of similar or related work experience
• Nationally Certified Pharmacy Technicians preferred
• Certification within state criteria may be required

Responsibilities

• Prepare prior authorizations and appeals.
• Communicate with providers, health plans, and PBMs.
• Submit PA/appeal requests via multiple channels.
• Maintain accurate PA documents and records.
• Ensure timely and compliant PA requests and appeals

Skills

MS Excel

MS Word

Outlook

Insurance verification

Prescription adjudication

Communication

Deadline management

Education

High school diploma or equivalent

Tools

Microsoft Excel

Microsoft Word

Outlook

Job description

Amber Specialty Pharmacy is seeking an Authorization Management Specialist to prepare appeal summaries and prior authorizations, communicating with prescribers and documenting in the EMR. The role requires knowledge of insurance verification and prescription adjudication, with HIPAA compliance and a high attention to detail.

The position is in the Operations department, reports to the Authorization Management Specialist, Lead, and involves coordinating with providers, health plans, PBMs, and