Prior Authorization Specialist: Detail-Driven

National Healthcare Solutions Group LLC; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

VerusRx is a PBM-focused company seeking a Prior Authorization Coordinator to process prior authorizations and provide quality customer service to members, providers, and plans. The role requires data entry accuracy and collaborative work with internal teams to support clinical reviews.

Candidates should have 2+ years in PBM or related settings, strong communication skills, and familiarity with CRM Dynamics for documentation and tracking. This position is full-time and US-based.

Qualifications

• Minimum 2 years’ PBM or related experience required.
• Ability to work cooperatively and master required software applications.
• Experience with prior authorization processing and clinical documentation.

Responsibilities

• Assist with PA issues from members, providers, pharmacies via phone and email.
• Document questions, issues, and resolutions in the CRM.
• Send outbound PA requests to provider offices and obtain required documentation.
• Respond to PA status inquiries from stakeholders.
• Finalize PA orders after clinical review and enter overrides.
• Monitor queues and meet turnaround time targets.

Skills

Prior authorization

Customer service

Data entry

CRM Dynamics

Pharmacy knowledge

Tools

Dynamics CRM

Job description

VerusRx is a PBM-focused company seeking a Prior Authorization Coordinator to process prior authorizations and provide quality customer service to members, providers, and plans. The role requires data entry accuracy and collaborative work with internal teams to support clinical reviews.

Candidates should have 2+ years in PBM or related settings, strong communication skills, and familiarity with CRM Dynamics for documentation and tracking. This position is full-time and US-based.