Pharmacy Prior Authorization Specialist - U.S. Healthcare

We are seeking a detail-oriented Pharmacy Prior Authorization Specialist with experience in U.S. pharmacy, prior authorization, or healthcare operations. The ideal candidate will be responsible for handling end-to-end pharmacy prior authorization requests, coordinating with pharmacies, physicians, insurance carriers, and PBMs, resolving claim-related issues, and ensuring timely approvals and renewals for U.S. patients.

Role Requirements

• Shift Timings (US Shift): 6:30 PM to 3:30 AM / 7:30 PM to 4:30 AM
• Working Days: Monday to Friday
• Employment Type: Full-Time, Permanent, WFO

Key Responsibilities

• Handle end-to-end pharmacy prior authorization requests for U.S. patients.
• Submit and follow up on prior authorizations, renewals, reconsiderations, and appeals.
• Coordinate with U.S. pharmacies, physicians, insurance carriers, and PBMs.
• Review insurance coverage, claim rejections, and required documentation.
• Resolve pharmacy claim rejections and coordinate with relevant stakeholders for resolution.
• Review and maintain accurate authorization and patient records.
• Ensure timely follow-ups on pending authorizations, renewals, and appeals.
• Work with payer portals and platforms such as CoverMyMeds to process authorization requests.
• Handle patient information in compliance with HIPAA and applicable U.S. healthcare requirements.
• Maintain accurate documentation and records of all authorization activities.

Required Skills & Experience

• 2+ years of experience in U.S. pharmacy prior authorization.
• Knowledge of U.S. pharmacy insurance, Medicare, Medicaid, and commercial insurance plans.
• Understanding of pharmacy claims, NDCs, and claim rejection resolution.
• Experience with CoverMyMeds or payer portals is preferred
• Strong English communication and interpersonal skills
• Excellent attention to detail and organizational skills
• Ability to manage multiple authorization requests and meet turnaround times