Prior Authorization Specialist

PharMerica; Louisville (KY); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Competitive pay and shift differential

Health, dental, vision, and life insur

Company-paid STD and LTD

Tuition assistance / reimbursement

Employee discount program

401(k)

Paid-time off

Job summary

PharMerica in Louisville, KY, is seeking a detail‑oriented Prior Authorization Coordinator to manage approvals for pharmacy claims and coordinate with prescribers and facility contacts when therapy changes are needed due to coverage.

You will track claims in QuickBase, prepare weekly spreadsheets, follow up within 4–5 business days, and support billing and operations while advocating for clients in a non‑retail, closed‑door environment.

Qualifications

• High school diploma or GED required.
• Kentucky Pharmacy Technician License preferred.
• Excellent customer service and written/verbal communication skills.
• Experience in healthcare billing, Medicaid/Medicare billing practices is a plus.
• Proficiency with Microsoft Word and Excel required.

Responsibilities

• Complete approvals for pharmacy claims requiring prior authorization and coordinate with prescribers/facility contacts for therapy changes when insurance does not cover the treatment.
• Follow up on all claims requiring prior authorization within four to five business days.
• Track and review all claims in QuickBase and provide an Excel tracking sheet to the Director weekly.
• Compare system reports of unbilled claims requiring prior approval to QuickBase tracking to ensure all authorizations are followed up.
• Assist Billing with resolving unbilled claims at month-end close.
• Advocate for clients as needed and support Pharmacy Operations.
• Adjudicate and resolve claim rejections and utilize Frameworks, QuickBase, Docutrack, and CoverMyMeds for daily workflow.

Skills

Customer service

Communication

Prioritization

Multi-tasking

Typing

Technical skills

Education

High School Diploma or GED

Tools

Microsoft Word

Excel

QuickBase

Docutrack

CoverMyMeds

Job description

Overview

PharMerica is a closed‑door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long‑term care and senior living clients. We offer a non‑retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for those looking for career progression.

Work Hours

Mon‑Fri: 8:30 am – 5:00 pm.

Benefits

• DailyPay
• Flexible schedules
• Competitive pay and shift differential
• Health, dental, vision, and life insurance benefits
• Company‑paid STD and LTD
• Tuition assistance / reimbursement
• Employee discount program
• 401(k)
• Paid‑time off

Position Posting

Position will be posted for a minimum of 7 business days.

Responsibilities

• The Prior Authorization Coordinator is responsible for completing approvals for pharmacy claims requiring prior authorization, or coordinating with prescribers and facility contacts to have therapy changed to a preferred alternative when insurance does not cover the treatment.

Essential Job Responsibilities

• Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts.
• Follow up on all claims requiring prior authorization within four to five business days.
• Track and review all claims in QuickBase and send an Excel tracking spreadsheet to the Director of Pharmacy weekly.
• Compare system reports of unbilled claims requiring prior approval to QuickBase tracking to ensure all required authorizations are followed up.
• Assist the Billing Department with resolving unbilled claims at each month‑end close.
• Advocate for clients as needed.
• Support Pharmacy Operations.
• Adjudicate and resolve claim rejections as needed.
• Utilize Frameworks, QuickBase, Docutrack, and CoverMyMeds to complete daily workflow.
• Perform other responsibilities as assigned.

Qualifications

• High School Diploma or General Education Diploma required.
• Kentucky Pharmacy Technician License preferred.
• Excellent customer service and communication skills, both written and verbal.
• Ability to prioritize and meet predetermined deadlines.
• Must be able to effectively multi‑task, be proficient at typing, and have advanced technical skills.
• Experience in a healthcare billing environment (pharmacy preferred).
• Familiarity with online claims processing and Medicaid and Medicare billing practices.
• Proficiency with Microsoft Word and Excel required.