Prior Authorization Specialist – CPhT

HealthCare Support; Montvale (NJ); On-site; USD 51,000 - 64,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

HSA-eligible plans

401(k) company match

Paid Time Off

Tuition reimbursement

Disability insurance

Life Insurance

Job summary

HealthCare Support is seeking a strategic, client-focused Prior Authorization Specialist (CPhT) in Montvale, NJ to join a growing PBM organization. In this in-office role, you’ll communicate with providers to process prior authorizations and work with internal Account Managers to process claims overrides.

This full-time position offers a Monday–Friday, 8:30 AM–5:00 PM schedule and a comprehensive benefits package that includes medical, dental, and vision insurance, HSA-eligible plans, a 401(k)

Qualifications

• Certified Pharmacy Technician (CPhT) required.
• 5 years of pharmacy experience.
• 2 years in claims adjudication.
• 2 years in prior authorization processes.
• 2 years of experience in a PBM OR health plan.
• Strong customer service orientation.
• Business acumen working in an office-setting.
• Ability to work in a fast-paced environment.

Responsibilities

• Provide efficient administrative and operational support to adjudication, prior authorization, and clinical review teams. Accurately process claim overrides and case documentation in accordance with standard operating procedures (SOPs). Ensure compliance with all turnaround times and quality metrics to meet member and client expectations. Assist clinical pharmacists and operations teams with workflow management and reporting needs.

Skills

Customer service

Concierge-level service

Office communication

Education

Certified Pharmacy Technician (CPhT)

Job description

Prior Authorization Specialist – CPhT – Montvale, NJ

HealthCare Support is seeking a strategic, client-focused Prior Authorization Specialist to join a growing PBM organization. In this highly collaborative role, you’ll communicate with providers to process prior authorizations and work with internal Account Managers to process claims overrides.

Schedule

• Monday–Friday, 8:30 AM–5:00 PM
• Fully in office schedule

Compensation

• $50,890 - $63,612 ($24.50–$30.60/hour)

Benefits

• Medical, dental, and vision insurance
• Multiple medical plan options, including HSA-eligible plans
• Benefits effective the 1st of the month following hire
• 401(k) company match: 50% of the first 4% contributed
• 100% immediate vesting
• Paid Time Off
• Tuition reimbursement
• Short-term and long-term disability
• Basic Life & AD&D insurance at 2x salary
• FSA and HSA options

Daily Responsibilities

• Provide efficient administrative and operational support to adjudication, prior authorization, and clinical review teams. Accurately process claim overrides and case documentation in accordance with standard operating procedures (SOPs). Ensure compliance with all turnaround times and quality metrics to meet member and client expectations. Assist clinical pharmacists and operations teams with workflow management and reporting needs.

Required Qualifications

• Certified Pharmacy Technician (CPhT) required
• 5 years of pharmacy experience
• 2 years in claims adjudication
• 2 years in prior authorization processes.
• 2 years of experience in a PBM OR health plan
• Strong customer service orientation and commitment to delivering concierge-level service
• Business acumen working in an office-setting
• Ability to work in a fast-paced environment

Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.