Prior Authorization Pro: Fast-Track Access to Therapy

Pinnacle Health Solutions; Fresno (CA); On-site; USD 60,000 - 85,000; Full time

Job summary

Pinnacle Health Solutions is seeking a PA Specialist to join the Clinical Pharmacy Programs team in Fresno, CA. The role focuses on initiating, processing, and tracking prior authorization requests to ensure timely access to therapy, with strong emphasis on HIPAA compliance and accurate documentation.

You will gather clinical data, communicate with prescribers, payers, and internal stakeholders, and maintain PA status updates in pharmacy systems and payer portals.

Qualifications

• HIPAA compliance awareness and secure handling of PHI.
• Strong attention to detail and ability to meet turnaround times.
• Ability to communicate with prescribers, payers, and stakeholders.

Responsibilities

• Initiate and process PA requests per payer requirements.
• Gather, verify, and submit clinical/administrative documentation via payer portals, fax, or phone.
• Enter and maintain PA status updates in systems; monitor turnaround times.
• Review denial communications and initiate appeals.
• Coordinate information from providers to support PA and appeals.
• Communicate PA requirements and status with prescribers and payer representatives.
• Coordinate appeal submission logistics and follow up on receipt/status.
• Escalate clinical questions to Clinical Pharmacist III as needed.
• Maintain complete documentation in accordance with policies.
• Ensure HIPAA-compliant communications throughout processes.

Skills

HIPAA compliance

Attention to detail

Communication with prescribers

Education

California Board of Pharmacy Technician license

Tools

Microsoft Excel

Job description

Pinnacle Health Solutions is seeking a PA Specialist to join the Clinical Pharmacy Programs team in Fresno, CA. The role focuses on initiating, processing, and tracking prior authorization requests to ensure timely access to therapy, with strong emphasis on HIPAA compliance and accurate documentation.

You will gather clinical data, communicate with prescribers, payers, and internal stakeholders, and maintain PA status updates in pharmacy systems and payer portals.