Prior Authorization Technician - Remote

Polaris Pharmacy Services; Fort Lauderdale (FL); Remote; USD 40,000 - 60,000; Full time

Job summary

Polaris Pharmacy Services is seeking a full-time Prior Authorization Technician to manage pharmacy claims and ensure timely billing. The role involves resolving rejected claims and collaborating with team members while providing excellent customer service. This remote position offers competitive benefits and opportunities for career advancement.

Benefits

Medical, Dental, Vision insurance

401(k), Life insurance, Disability insurance

Tuition reimbursement

Paid holidays and PTO

Qualifications

• At least one year experience as a pharmacy technician, preferably in long-term care.
• Basic computer skills required.
• Ability to work various shifts and adapt to changing environments.

Responsibilities

• Manage and identify rejected pharmacy claims to maximize reimbursement.
• Research and resolve rejected claims with Medicare D plans and insurance companies.
• Collaborate with team to identify and resolve billing issues.

Skills

Customer service

Organizational skills

Problem-solving

Education

High School diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

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Who We Are
Polaris Pharmacy Services is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies. We offer competitive benefits, industry pay, and opportunities for career advancement. We are currently recruiting experienced Prior Authorization Technicians to join our team.

Overview
The Prior Authorization Specialist manages rejected pharmacy claims to ensure maximum payer reimbursement and timely billing, reducing financial risks. They must be responsive and courteous, understanding customer needs, and maintaining effective relationships with co-workers and customers.

Responsibilities

• Manage and identify rejected pharmacy claims to maximize reimbursement and ensure timely billing.
• Research and resolve rejected claims with Medicare D plans, insurance companies, and Medicaid, adhering to deadlines.
• Perform edits and reversals to ensure maximum reimbursement.
• Contact providers or customers for additional information as needed.
• Monitor revenue at risk related to payer setup, billing, and reversals.
• Collaborate with team to identify and resolve billing issues.
• Submit necessary payer paperwork promptly.
• Review billing exception reports for accuracy.
• Handle non-standard billing transactions.
• Support training and maintain processing reports.
• Follow all relevant regulations, including HIPAA.
• Perform other duties as assigned, depending on business needs.

Qualifications

• High School diploma or equivalent.
• At least one year experience as a pharmacy technician, preferably in long-term care.
• Basic computer skills, including Microsoft Word, Excel, Outlook.
• Strong customer service, organizational, and problem-solving skills.
• Ability to work various shifts, adapt to changing environments.

Physical Demands

• Sitting or standing for 7-10 hours daily.
• Occasional lifting up to 50 pounds.

Holiday & PTO Policy

• Paid holidays (6 days), sick days (5), and up to 10 PTO days annually.

Benefits for Full-Time Employees

• Medical, Dental, Vision insurance.
• 401(k), Life insurance, Disability insurance.
• Tuition reimbursement, PTO, and career growth opportunities.

Additional Details

• Position is full-time, remote, with some requirements for overtime, holidays, and weekends.