Pharmacy Authorization Specialist

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BRSi

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

BRSi is a company that specializes in providing customized solutions to improve healthcare efficiency and revenue management. With over 30 years of experience, BRSi focuses on empowering revenue growth and compliance through advanced technology platforms. The company offers solutions that maximize reimbursements, streamline federal programs, and enhance operational efficiency for publicly funded healthcare providers and other organizations. BRSi's expertise in healthcare financial processes and health information technology helps in delivering superior patient care through better financial health.

📋 Description

• 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

• 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

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