Prior Authorization Specialist - 250193

Pharmacy Prior Authorization SpecialistPlano, TX (Fully Onsite)$21 – $28 per hourMonday – Friday | 8:30 AM – 5:00 PMAbout the RoleWe are seeking a Pharmacy Prior Authorization Specialist to support complex specialty medication workflows and ensure timely access to therapy for patients. This role plays a critical part in managing prior authorization processes, coordinating with insurance payers, and collaborating with clinical and pharmacy teams.The ideal candidate is detail-oriented, proactive, and comfortable navigating insurance systems while communicating with payers, patients, and healthcare professionals. Candidates with pharmacy or healthcare insurance experience who enjoy problem-solving and working in a fast-paced environment will thrive in this role.Key ResponsibilitiesPrior Authorization & Benefits CoordinationContact insurance companies to obtain real-time status updates on prior authorization requestsRun benefit investigations and gather documentation needed for commercial insurance authorizationsCheck status daily on pending authorizations and ensure timely follow-upAssist with continuation authorizations for existing patientsDocumentation & Data ManagementAccurately enter approval letters, authorization numbers, and related documentation into internal systems such as CareTendEnter patient demographics, diagnosis information, and payor data into the electronic medical recordMaintain detailed records of payer interactions including reference numbers and next stepsDenial Review & Workflow ManagementReview denial letters and ensure documentation is complete before routing cases to clinical teams for review and appealsMonitor authorization queues to prevent delays in patient therapy initiation or continuationConduct patient chart audits and maintain current documentation filesCollaboration & CommunicationCoordinate with pharmacy operations, intake teams, clinical staff, and revenue cycle teamsCommunicate authorization outcomes and documentation needs to internal teamsMaintain professional communication with insurance representatives, patients, and referral sourcesRequired QualificationsHigh School Diploma or GED1+ year of experience in a pharmacy, healthcare, or medical insurance environmentExperience with prior authorizations, benefits verification, or insurance coordinationStrong attention to detail and data entry accuracyAbility to manage multiple tasks and changing priorities in a fast-paced environmentExperience with Microsoft Office (Excel, Outlook, Word, Teams)Preferred QualificationsPharmacy Technician Certification (preferred but not required)Experience with CareTend or similar pharmacy/authorization platformsKnowledge of Medicare, Medicaid, and commercial insurance plansExperience in pharmacy billing, specialty pharmacy, or medical insurance verification