Pharmacy Authorization Specialist

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BRSi

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💸 Finance

☁️ SaaS

Healthcare Insurance • Finance • SaaS

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

• Coordinating prior authorizations, insurance verifications, medication approvals, and medical service approvals • Working closely with providers, pharmacies, insurance companies, and internal clinical or billing teams to obtain required approvals • Resolving authorization issues, and maintaining complete documentation • Frequent computer use, phone communication, insurance portal access, and coordination with multiple departments • This position typically reports to their Regional Manager, DOD Operations Manager, or Project Manager

🎯 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 • Comply with HIPAA, payer policies, organizational procedures, and applicable healthcare regulations