Remote Pharmacy Prior-Authorization Specialist

JobRx, Inc.; New Britain (CT); Remote; USD 38,000 - 55,000; Full time

Benefits offered by this job

Remote work opportunity

In-office option in East Hartford

Flexible schedule

Generous vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies in Connecticut is seeking a Pharmacy Prior Authorization Call Center Representative to support the Connecticut Medicaid account in a fast-paced, high-volume environment.

You will handle pharmacy claims and prior authorization inquiries, strive to resolve issues within 24 hours, and adhere to HIPAA and Medicaid guidelines while working a rotating shift schedule, including remote work from CT.

Qualifications

• Knowledge of pharmacy claims processing and dispensing systems.
• Exposure to Medicaid and/or Medicare Part D programs.
• Ability to work in a high-paced, high-volume environment with strong multitasking and time management.
• Proficient with Microsoft Office Suite (Word, Excel, Outlook).
• Active Connecticut Pharmacy Technician license.

Responsibilities

• Serve as the primary contact for prescribers and pharmacies on claims and prior authorization inquiries.
• Analyze claims and provide clarification, verification, and resolution to provider inquiries.
• Process prior authorization requests, including approvals and denials, with documented rationale.
• Accurately document all call interactions and resolutions in the system.
• Maintain confidentiality and compliance with HIPAA and Connecticut Medicaid guidelines.

Skills

pharmacy claims processing

high-paced environment

multi-tasking

time management

verbal communication

written communication

Microsoft Office Suite

Education

Active Connecticut Pharmacy Technician license

Tools

pharmacy dispensing systems

Medicaid/Medicare Part D systems

Job description

Gainwell Technologies in Connecticut is seeking a Pharmacy Prior Authorization Call Center Representative to support the Connecticut Medicaid account in a fast-paced, high-volume environment.

You will handle pharmacy claims and prior authorization inquiries, strive to resolve issues within 24 hours, and adhere to HIPAA and Medicaid guidelines while working a rotating shift schedule, including remote work from CT.