Prior Authorization Specialist

LTC PHARMA HLDG LLC

Rockaway (NJ)

On-site

USD 42,000 - 64,000

Full time

14 days+

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Benefits offered by this job

Medical, Dental, and Vision insurance

401(k) plan

Tuition reimbursement

Career growth potential

Paid holidays and PTO

Job summary

Polaris Pharmacy Services is seeking a Prior Authorization Specialist to manage rejected pharmacy claims, optimize payer reimbursement, and ensure timely billing. The role requires attention to detail, strong data entry, and proficiency with Word, Excel, and Outlook.

You will work in a fast-paced environment, collaborate with healthcare providers, and support training and reporting obligations while adhering to HIPAA and company policies.

Qualifications

High School diploma or equivalent required.
Minimum 1+ year of pharmacy technician experience preferred (retail or long-term care).
Framework LTC knowledge and 10-key number entry preferred.

Responsibilities

Manage a portfolio of rejected pharmacy claims to maximize payer reimbursement and timely billing.
Research and resolve rejected claims with national Medicare D plans, third-party insurers, and Medicaid.
Ensure approved claims by edits and reversals to maximize reimbursement.
Contact providers or facility contacts for additional information.
Prepare and maintain reports and records for processing.
Follow HIPAA and regulatory requirements.
Assist with prior authorizations and cross-functional tasks as needed.

Skills

English language

Data entry

Microsoft Word

Microsoft Excel

Outlook

Customer service

Attention to detail

Reliability

Problem solving

Adaptability

Education

High School diploma or equivalent

1+ years pharmacy technician experience (retail/long-term care)

10-key number entry experience

Tools

10-key Number Entry

LTC knowledge

Job description

WHO WE ARE

At Polaris Pharmacy Services, we're more than a pharmacy - we're a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we're raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support.

Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job - we provide competitive pay, robust benefits, and genuine opportunities for career advancement.

If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us.

JOB SUMMARY

The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. The Prior Authorization Specialist must be responsive and courteous when addressing the customers' needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers' trust and respect.

DUTIES/RESPONSIBILITIES

Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers
Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
Contact providers and/or facility contacts as necessary to obtain additional information
Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes
Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
Complete, communicate, and submit prior authorizations forms in a timely manner
Support training needs
Prepare and maintain reports and records for processing
Perform other tasks as assigned.
Follow all applicable government regulations, including HIPAA
Comply with departmental policies regarding safety, attendance, and dress code
Overtime, holidays, and weekends may be required and/or expected
Conduct job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
Other duties as assigned; Job duties may vary depending on business needs

QUALIFICATIONS/COMPETENCIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

REQUIRED SKILLS/ABILITIES

Able to read, write, speak, and understand the English language
Able to retain a large amount of information and apply that knowledge to related situations
Able to work in a fast-paced environment
Basic computer knowledge skills required
Basic math and analytical skills
Experience with alpha-numeric data entry
Proficient in Microsoft Word, Excel, and Outlook required
Customer Service
Results-oriented
Good organization/Attention to detail
Reliable
Problem solver
Able to work various shifts and days
Adaptability to an ever-changing environment

EDUCATION and/or EXPERIENCE

High School diploma or equivalent required
Minimum of one (1) or more years working as a pharmacy technician in a retail environment preferred (long-term care pharmacy preferred)
Framework LTC & General computer knowledge & 10-key Number Entry preferred

PHYSICAL DEMANDS

May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
May be necessary to work extended hours as needed
May lift and/or move up to 30 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY

Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.

Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.

BENEFITS for full time Employees