Prior Authorization Specialist: Detail-Oriented & Collaborative

VerusRx; United States; On-site; USD 42,000 - 65,000; Full time

Job summary

VerusRx is seeking a Prior Authorization Coordinator to accurately process PA determinations using our PA software and data-entry workflows. You will provide high-quality customer service to internal and external customers via email and phone.

The role requires attention to detail, clear communication, and the ability to work independently and with cross-functional teams to ensure timely PA outcomes.

Qualifications

• Minimum of 2 years’ experience in PBM or related (retail or hospital pharmacy).
• C.Ph.T license desired.
• Ability to work cooperatively and master software applications as required.
• Understanding of PA processing and data entry workflows.

Responsibilities

• Assist with calls transferred from Member Service Representatives (MSRs) for prior authorization-related issues; research and resolve questions from members, providers, pharmacies, and other callers, including explaining PA denials.
• Document callers’ questions, issues, and resolution in the CRM (Dynamics).
• Send outbound PA request forms via fax to provider offices to initiate prior authorizations and follow up by phone as needed to obtain required clinical documentation.
• Respond to emails to initiate prior authorizations and address PA status inquiries from internal and external stakeholders (e.g., providers, members, internal teams).
• Finalize PA orders following clinical review by a Pharmacist or PA Technician, documenting the decision in the CRM (Dynamics) and entering overrides upon approval.
• Monitor assigned queue(s) and case volume to help meet turnaround time (TAT) targets.
• Meet and/or exceed production, quality, attendance, and adherence standards.
• Perform other duties as assigned.

Skills

PBM experience

Pharmacy background

Data entry

CRM knowledge

Education

C.Ph.T license

Job description

VerusRx is seeking a Prior Authorization Coordinator to accurately process PA determinations using our PA software and data-entry workflows. You will provide high-quality customer service to internal and external customers via email and phone.

The role requires attention to detail, clear communication, and the ability to work independently and with cross-functional teams to ensure timely PA outcomes.