Remote Prior Authorization Specialist (Medicare/Medicaid)

Talentify; Rhode Island; Hybrid; USD 45,000 - 65,000; Full time

Job summary

US Tech Solutions is seeking a Prior Authorization Specialist for a fully remote role. You will handle inbound and outbound calls from providers, members and pharmacies, document reviews, and coordinate with pharmacists to resolve coverage requests.

The position requires researching Medicare Part D guidelines, using multiple systems to process PA requests, and ensuring CMS compliance. A proactive, detail-oriented communicator with PBM/pharma exposure is preferred.

Qualifications

• 0–3 years in a customer service or call center environment handling a high volume of calls.
• Six months of PBM/pharmaceutical related work strongly desired.
• Two+ years of general business experience including problem resolution, business writing and quality improvement.

Responsibilities

• Utilizing multiple software systems to complete Medicare appeals case reviews
• Meeting or exceeding government mandated timelines
• Complying with turnaround time, productivity and quality standards
• Conveying resolution to beneficiary or provider via professional communication

Skills

Prior Authorization

Medicare and Medicaid

Education

High School diploma or GED

Job description

US Tech Solutions is seeking a Prior Authorization Specialist for a fully remote role. You will handle inbound and outbound calls from providers, members and pharmacies, document reviews, and coordinate with pharmacists to resolve coverage requests.

The position requires researching Medicare Part D guidelines, using multiple systems to process PA requests, and ensuring CMS compliance. A proactive, detail-oriented communicator with PBM/pharma exposure is preferred.