Prior Authorization Specialist

Premium Services 247; Pottsville (Schuylkill County); On-site; USD 48,000 - 64,000; Full time

Benefits offered by this job

Medical insurance

Paid vacation and paid holidays

401(k) retirement plan

Job summary

Concept Billing Solutions in Pottsville, PA is seeking a proactive Prior Authorization Specialist to help patients receive timely access to prescription medications. You will manage authorization requests from submission through resolution, collaborating with insurers, physician offices, nursing facilities, and pharmacy teams.

Key responsibilities include submitting PA requests, verifying payer requirements, tracking decisions, and coordinating appeals when needed.

Qualifications

• Experience with prior authorization, pharmacy claims, or insurance billing.
• LTC pharmacy experience and Medicare/Medicaid knowledge a plus.
• Strong organizational skills and the ability to handle competing deadlines.
• Clear communication and effective problem-solving abilities.
• Willingness to learn multiple systems; proficient in Microsoft Office.
• Ability to work independently and with cross-functional teams.

Responsibilities

• Prepare and submit prescription prior authorization requests with supporting documentation.
• Review payer requirements and obtain needed clinical/insurance information.
• Monitor pending requests, follow up on decisions, and prioritize time-sensitive cases.
• Investigate claim rejections and coordinate appeals or additional documentation.
• Communicate status updates to providers, facilities, insurers, and internal teams.
• Maintain records and own open requests until resolved.

Skills

Prior authorization

Pharmacy claims

Insurance billing

Medicare/Medicaid knowledge

Microsoft Office

Cross-functional teamwork

Organizational skills

Communication skills

Job description

Full-Time | On-Site | 221 West Market Street, Pottsville, PA 17901

Concept Billing Solutions is seeking a proactive Prior Authorization Specialist to help patients receive timely access to prescription medications. You will manage authorization requests from submission through resolution while working closely with insurers, physician offices, nursing facilities, and pharmacy teams.

What You’ll Do

• Prepare and submit prescription prior authorization requests with accurate supporting documentation.
• Review payer requirements and obtain needed clinical and insurance information from appropriate partners.
• Monitor pending requests, follow up on decisions, and prioritize time-sensitive cases.
• Investigate authorization-related claim rejections and coordinate appeals or additional documentation when needed.
• Communicate status updates and outstanding requirements to providers, facilities, insurers, and internal teams.
• Maintain thorough records and take ownership of open requests until resolved.

What We’re Looking For

• Prior authorization, pharmacy claims, insurance billing, or related healthcare insurance experience preferred.
• LTC pharmacy experience and familiarity with Medicare, Medicaid, or commercial prescription coverage are pluses.
• Strong organizational skills and ability to manage competing deadlines.
• Clear, professional communication and effective problem-solving skills.
• Comfort learning multiple systems; proficiency with Microsoft Office.
• Ability to work independently and collaborate with a cross-functional team.

Benefits

• Medical insurance
• Paid vacation and paid holidays
• 401(k) retirement plan

About Concept Billing Solutions

Concept Billing Solutions is a growing medical billing and revenue cycle management company serving healthcare organizations. Our team supports clients with billing, insurance coordination, prior authorizations, and related administrative services. We value accuracy, responsiveness, teamwork, and dependable follow-through.