Prior Authorization Specialist

Concept Pharmacy; Pottsville (Schuylkill County); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Paid vacation and paid holidays

401(k) retirement plan

Job summary

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.

Ideal candidates bring prior authorization or insurance billing experience, strong organization, clear communication, and comfort learning multiple systems, including Microsoft

Qualifications

• 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.

Responsibilities

• 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.

Skills

Prior Authorization

Pharmacy Claims

Insurance Billing

Microsoft Office

Independent Work

Cross-functional Collaboration

Tools

Microsoft Office

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.