San Antonio, TX · On-site
$18.50 - $24/hr
Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired.
San Antonio, TX · On-site
$18.50 - $24/hr
Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired.
Scottsdale, AZ · On-site
$20.75 - $26.75/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Scottsdale, AZ · On-site
$20.75 - $26.75/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Cleveland, OH · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Cleveland, OH · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Burlington, VT · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Burlington, VT · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Woodridge, IL · On-site +1
$20.25 - $26.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Woodridge, IL · On-site +1
$20.25 - $26.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
San Antonio, TX · On-site
$19.30 - $28.75/hr
Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired.
San Antonio, TX · On-site
$19.30 - $28.75/hr
Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired.
Norwood, OH · On-site
$18 - $23.50/hr
... pharmacy services ... If you enjoy problem-solving, working with insurance and benefits, and making a meaningful ...
Norwood, OH · On-site
$18 - $23.50/hr
... pharmacy services ... If you enjoy problem-solving, working with insurance and benefits, and making a meaningful ...
Manchester, NH · Remote
$20 - $22/hr
???? Pharmacy Technician - Prior Authorizations & Medication Access???? Fully Remote | New Hampshire ... In this remote role, you will work closely with patients, insurance providers, healthcare ...
Manchester, NH · Remote
$20 - $22/hr
???? Pharmacy Technician - Prior Authorizations & Medication Access???? Fully Remote | New Hampshire ... In this remote role, you will work closely with patients, insurance providers, healthcare ...
Salt Lake City, UT · On-site
$19.75 - $25.75/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Salt Lake City, UT · On-site
$19.75 - $25.75/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Houston, TX · On-site
$19.50 - $25.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Houston, TX · On-site
$19.50 - $25.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Indianapolis, IN · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Indianapolis, IN · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Pittsburgh, PA · Remote
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Pittsburgh, PA · Remote
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Houston, TX · On-site +1
$19.50 - $25.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Houston, TX · On-site +1
$19.50 - $25.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Indianapolis, IN · Remote
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Indianapolis, IN · Remote
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Louisville, KY · On-site +1
$18.75 - $24.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Louisville, KY · On-site +1
$18.75 - $24.25/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Waltham, MA · On-site +1
$22.25 - $29/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Waltham, MA · On-site +1
$22.25 - $29/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Waltham, MA · On-site
$22 - $28.50/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Waltham, MA · On-site
$22 - $28.50/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Hartford, CT · On-site +1
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Hartford, CT · On-site +1
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Saint Louis, MO · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
Saint Louis, MO · On-site
$23/hr
Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...
$14.42 - $15.49
3% of jobs
$15.49 - $16.56
18% of jobs
$16.82 is the 25th percentile. Wages below this are outliers.
$16.56 - $17.64
17% of jobs
The median wage is $18.41 / hr.
$17.64 - $18.71
17% of jobs
$18.71 - $19.78
17% of jobs
$20.13 is the 75th percentile. Wages above this are outliers.
$19.78 - $20.85
11% of jobs
$20.85 - $21.92
7% of jobs
$21.92 - $22.99
5% of jobs
$22.99 - $24.06
3% of jobs
$24.06 - $25.13
1% of jobs
$25.13 - $26.20
1% of jobs
$14
$19
$26
A Pharmacy Insurance job involves assisting patients, pharmacies, and healthcare providers in navigating insurance coverage for medications. Responsibilities may include verifying insurance benefits, processing claims, resolving billing issues, and ensuring patients receive necessary medications at the lowest possible cost. Professionals in this role often work for pharmacies, insurance companies, or healthcare organizations. Strong communication skills, attention to detail, and knowledge of insurance policies are essential for success in this field.
Professionals in Pharmacy Insurance frequently encounter challenges such as handling complex insurance policies, resolving claim denials, and staying current with constantly changing healthcare regulations. Coordinating with pharmacies, patients, insurance companies, and healthcare providers requires strong communication and negotiation skills as discrepancies or billing issues often arise. Many also face high volumes of documentation and must manage sensitive patient information with strict attention to confidentiality and accuracy. Overcoming these challenges is crucial for ensuring timely medication access and overall patient satisfaction.
To excel in Pharmacy Insurance roles, strong knowledge of pharmacy benefit management, insurance claims processing, and healthcare regulations—often supported by a background in pharmacy, healthcare administration, or similar fields—is required. Experience with pharmacy management systems, insurance billing software, and familiarity with coding (e.g., ICD-10, CPT) are highly beneficial. Attention to detail, problem-solving ability, and effective communication skills help professionals navigate complex insurance procedures and resolve issues with patients and providers. Mastery of these skills ensures accurate claims processing, minimizes denials, and enhances the customer experience within the healthcare system.
Cities with the most Pharmacy Insurance job openings:
The most popular types of Pharmacy Insurance jobs are:
States with the most job openings for Pharmacy Insurance jobs include:
The top searched job categories for Pharmacy Insurance jobs are:
$18.50 - $24/hr
Full-time
Posted 19 days ago
8.0
Based on 64 frontline employees who took The Breakroom Quiz
89th of 898 rated healthcare providers
POSITION SUMMARY/RESPONSIBILITIES
Prepares pharmacy prior authorization requests for review by nurse/pharmacist/physician reviewers. Completes pharmacy authorization requests and issues review outcome notifications to Community First Health Plans (CFHP) members and providers. Follows clinical criteria and instructions to approve prior authorization requests based on established criteria, plan policies and procedures. Performs non-medical research including eligibility verification and benefits verification. Reviews medication utilization reports and identifies trends through advanced data analytics. Produces reports to comply with regulatory and accreditation standards
EDUCATION/EXPERIENCE
Graduation from high school/GED required. Bachelor’s degree preferred. Five years of pharmacy experience required. Some coursework at the college level is preferred. Excellent customer service, phone etiquette, attention to detail, and typing skills is required. Basic knowledge of Microsoft Office and internet required. Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired. Knowledge of InterQual screening criteria as well as DRG, ICD-10 and CPT coding is preferred.
LICENSURE/CERTIFICATION
Texas State Board of Pharmacy registration required. Certification as a Pharmacy Technician (CPhT) is required.
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