Pharmacy Authorization Specialist

BRSi

Pharmacy Authorization Specialist coordinating prior authorizations and insurance verifications. Collaborates with providers, pharmacies, and insurance companies for effective patient care and reimbursement.

Posted 7/31/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in coordinating prior authorizations, insurance verifications, and medication approvals while ensuring compliance with HIPAA and payer policies. Proficient in utilizing electronic health records and practice management systems to support efficient revenue cycle operations.

Highest-signal resume keywords

Prior Authorization CoordinationInsurance VerificationMedical BillingElectronic Health Records ProficiencyStrong Communication Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical TerminologyPharmacy TerminologyICD-10CPTHCPCSNDC NumbersAuthorization ProcessesClinical Documentation InterpretationPayer RequirementsRevenue Cycle Support

Soft Skills

Written CommunicationVerbal CommunicationProfessional Interaction

Tools & Technologies

Pharmacy SystemsInsurance PortalsPractice Management SystemsStandard Office Software

Industry Keywords

HIPAA ComplianceMedicareMedicaidCommercial Insurance PlansSpecialty Pharmacy AuthorizationsPharmacy Benefit Managers

About the role

Key responsibilities & impact

Coordinate prior authorizations, insurance verifications, medication approvals, and medical service approvals to support timely patient care and accurate reimbursement.
Work closely with providers, pharmacies, insurance companies, and internal clinical or billing teams to obtain required approvals, resolve authorization issues, and maintain complete documentation.
Review provider orders, prescriptions, medical records, and insurance requirements to determine whether prior authorization is needed.
Submit authorization requests for medications, diagnostic testing, procedures, durable medical equipment, and other covered services.
Verify patient insurance eligibility, benefits, coverage limitations, deductibles, copays, and payer-specific authorization requirements.
Communicate with insurance companies, pharmacy benefit managers, pharmacies, provider offices, and patients to obtain missing information and follow up on pending requests.
Document authorization status, approvals, denials, appeals, reference numbers, effective dates, and follow-up actions accurately in the appropriate system.
Track authorization requests to ensure timely completion and reduce delays in treatment, medication access, or scheduled services.
Research and resolve authorization denials, discrepancies, claim issues, and payer requests for additional documentation.
Assist with appeals, reconsiderations, peer-to-peer coordination, and resubmission of corrected authorization requests when needed.
Maintain compliance with HIPAA, payer policies, organizational procedures, and applicable healthcare regulations.
Collaborate with billing, clinical, pharmacy, scheduling, and patient services teams to support continuity of care and revenue cycle efficiency.

Requirements

What you’ll need

High school diploma or equivalent required; associate degree in healthcare administration, medical billing, pharmacy technology, or a related field preferred.
Previous experience in prior authorization, pharmacy, medical billing, insurance verification, healthcare administration, or revenue cycle support preferred.
Knowledge of medical terminology, pharmacy terminology, insurance plans, prior authorization processes, and payer requirements.
Ability to read and interpret clinical documentation, prescription information, insurance guidelines, and authorization criteria.
Proficiency with electronic health records, pharmacy systems, insurance portals, practice management systems, and standard office software.
Strong written and verbal communication skills with the ability to interact professionally with patients, providers, pharmacies, and insurance representatives.
Experience working with Medicare, Medicaid, commercial insurance plans, specialty pharmacy authorizations, or pharmacy benefit managers (preferred).
Familiarity with ICD-10, CPT, HCPCS, NDC numbers, formularies, quantity limits, and medical necessity criteria (preferred).
Experience assisting with appeals, denied claims, specialty medication approvals, or high-volume authorization workflows (preferred).

Benefits

Comp & perks

Standard business hours are common, though schedules may vary based on organizational needs