Senior Pharmacy Prior Authorization Representative
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Pharmacy prior authorization representative supporting fertility patients and clinics for Evernorth Health Services. Processing claims, benefits, and authorizations across pharmacy and clinical systems.
Responsibilities:
- Enter prescriptions accurately into the system, adjudicate claims, and work rejections
- Use clinic-specific EMR systems to gather information for prior authorizations
- Adhere to program-specific contractual agreements and company practices
- Investigate processing and benefit inquiries from the Fertility Inside Sales team
- Conduct insurance inquiries and benefit checks
- Submit, follow up on, and appeal prior authorizations as needed
- Help patients and providers understand pharmacy benefits and answer questions
- Handle internal and external prior authorization inquiries
- Participate in program-specific customer meetings and training sessions
- Participate in special projects and perform other duties related to contract performance
- Work with a specialized team supporting specific groups of clinics and high-touch patient programs
Requirements:
- High School Diploma or GED required
- 2+ years of Pharmacy Technician experience
- Valid National Pharmacy Technician certification required
- Valid Arizona, Massachusetts, or Illinois State pharmacy technician license required
- Microsoft Office proficiency and data entry skills
- Strong math skills related to prescription calculations
- Exceptional attention to detail, accuracy, and quality
- Excellent verbal and written communication skills
- Ability to multitask in both PC/Phone related tasks
- 1+ year relevant experience with prior authorization submission using CoverMyMeds or similar electronic prior authorization tools
- Experience with prior authorization appeals and denials
- Experience working with clinical EMR systems and/or infertility is a plus, but not required
- Ability to prioritize and manage workload and meet deadlines
- If working at home, cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload
- Ability to work the specified weekday shifts and weekends as needed
Benefits:
- Annual bonus plan eligibility
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
Similar Jobs
Pharmacy Strategy Advancement Advisor
Pharmacy Strategy Advancement Advisor guiding data-driven strategy and business intelligence for Humana’s U.S. healthcare services. Leading complex analysis, recommendations, and executive-facing initiatives.
Certified Pharmacy Technician, Illinois
Certified Pharmacy Technician supporting members, providers, and pharmacies with claims, benefits, and prior authorizations. Gainwell delivers healthcare technology and services through remote pharmacy operations.
Certified Pharmacy Technician
Certified Pharmacy Technician supporting Gainwell’s healthcare programs with pharmacy claims, benefits, and prior authorizations. Resolving member and provider inquiries remotely while maintaining compliant documentation.
Pharmacy Technician
Part-time remote Pharmacy Technician transcribing prescription and diagnosis data into web applications. Supporting CVS Health’s patient-focused standardized health documentation.
Specialty Pharmacy Technician, CPhT/ExCPT
Remote Specialty Pharmacy Technician enrolling patients, managing prescriptions, and supporting prior authorizations for Lumicera specialty pharmacy. Handling patient and provider calls while maintaining accurate pharmacy records.
Pharmacy Technician I
Remote Pharmacy Technician I handling refill requests, pharmacy coordination, and patient support for Oak Street Health. Managing calls, prescriptions, appointments, and care-team updates.
Pharmacy Health Representative
Pfizer Pharmacy Health Representative driving strategic pharmacy sales and brand execution across North Brisbane. Building pharmacy relationships, managing account plans, and achieving sales targets.
Pharmacist
Pharmacist overseeing technicians, prescriptions, and USP 795/800 compounding at Revelation Pharma. Managing medication quality, inventory, and patient/provider consultations.
Clinical Pharmacist
Clinical Pharmacist improving medication adherence and quality measures for Healthfirst’s Essential Plan and Medicare members. Supporting outreach, regulatory compliance, and clinical pharmacy initiatives.
Pharmacy Technician, CPhT
Remote CPhT handling medication renewals for HarmonyCares’ in-home primary care patients. Supporting centralized patient advocacy, EMR documentation, and prescription workflows.
Clinical Pharmacist – Cost Containment
Clinical Pharmacist optimizing medication utilization and cost-containment programs for TrueScripts, a transparent prescription benefit manager. Analyzing clinical and financial outcomes while supporting PBM operations.
Clinical Review Pharmacist
Clinical Review Pharmacist reviewing prior authorizations and appeals for SmithRx’s technology-driven pharmacy benefit management platform. Supporting members, providers, pharmacies, and clinical programs remotely.
Pharmacy Assistant
Remote Pharmacy Assistant processing prescriptions, inventory, billing, and medication shipments. Supporting Sentrex Health Solutions’ Canadian specialty pharmacy and patient-support programs.
Pharmacist
Remote Canadian Pharmacist dispensing specialty medications and supporting clinics for Sentrex Health Solutions. Managing prescription verification, patient counselling, billing, inventory, and compounding.
Associate Director – Pharmacy Hub Operations
Associate Director launching and leading patient and provider service operations for CenterWell Pharmacy. Managing omnichannel support, workforce performance, quality, compliance, and complex resolutions.
Healthcare Consulting Associate – Pharmacy
Healthcare consulting associate leading pharmacy project workstreams for Huron. Improving hospital operations, clinical outcomes, cost structures, and sustainable performance through data-driven recommendations.
Pharmacist 2, Inpatient – Centralized Order Verification for the Enterprise
Inpatient Pharmacist verifying enterprise medication orders for the University of Rochester medical center. Supervising dispensing, clinical pharmacy care, technicians, and medication safety processes.
Clinical Pharmacist
Clinical Pharmacist optimizing medication therapy and chronic disease outcomes through WellDyne’s clinical programs. Conducting patient consultations, drug reviews, and provider engagement remotely.
Pharmacy Intern
Unpaid part-time Pharmacy Intern supporting Humana’s healthcare and insurance services remotely in South Carolina. Completing pharmacy assignments while pursuing formal education.
Senior Integrated Clinic Pharmacist
Clinical pharmacist managing medications, education, and quality initiatives for Conviva’s senior primary care patients. Supporting high-risk chronic-care outcomes across remote clinic operations.