Prior Authorization Specialist: Fast-Track Approvals & Appeals

Western Growers; Fresno (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Western Growers in Fresno, CA is seeking a Prior Authorization Specialist to support the clinical pharmacy team by initiating, processing, and tracking PA requests, gathering documentation, and communicating with prescribers, payers, and internal staff.

The role emphasizes HIPAA compliance, accuracy, timely turnaround, and collaboration with Clinical leadership to render decisions per guidelines.

Qualifications

• High school diploma or equivalent; five years of retail pharmacy experience and/or PBM experience; prior authorization experience preferred.
• Current California Pharmacy Technician license (required).
• Proficiency with pharmacy systems and documentation; experience using insurer portals, phone/fax communication; strong Microsoft Office skills (Excel and Word).
• Ability to understand and apply clinical criteria to requests for coverage at all times.
• Highly organized and detail oriented; able to interact effectively with internal and external customers.

Responsibilities

• Initiate and process PA requests per payer requirements and internal workflows.
• Gather, verify, and submit clinical/administrative documentation via payer portals, fax, or phone.
• Enter PA status updates in pharmacy systems; monitor turnaround times and follow up.
• Review denial communications and retrieve supporting documentation for appeals as needed, escalate when required.

Skills

Communication skills

Organizational skills

Attention to detail

Provider outreach

Education

High school diploma or equivalent

Tools

Excel

Word

Pharmacy systems

Job description

Western Growers in Fresno, CA is seeking a Prior Authorization Specialist to support the clinical pharmacy team by initiating, processing, and tracking PA requests, gathering documentation, and communicating with prescribers, payers, and internal staff.

The role emphasizes HIPAA compliance, accuracy, timely turnaround, and collaboration with Clinical leadership to render decisions per guidelines.