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Remote Prior Authorization Representative Express Scripts Jobs in Massachusetts

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site +1

$22.25 - $29/hr

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

UnitedHealth Group

Clinical Appeals RN

Boston, MA · Remote

$28.94 - $51.83/hr

Represent MassHealth at appeal hearings * Defend MassHealth prior authorization decisions by utilizing program specific regulations, medical necessity guidelines, standards of care and best practices

Promoted2

Remote Insurance Agent

Boston, MA · Remote

$60K - $110K/yr

We provide all tools, comprehensive training, proven scripts, and mentorship needed to build a ... Prior experience in sales, customer service, or financial services * Background in remote or ...

micro1 AI

Cheminformatics Specialist - Remote

Lynn, MA · Remote

$80 - $110/hr

No prior experience in AI is required -- your domain knowledge is what matters. Scope of Work ... Strong coding proficiency in Python (beyond analysis scripts), with hands-on experience building ...

micro1 AI

Cheminformatics Specialist - Remote

Lowell, MA · Remote

$80 - $110/hr

No prior experience in AI is required -- your domain knowledge is what matters. Scope of Work ... Strong coding proficiency in Python (beyond analysis scripts), with hands-on experience building ...

micro1 AI

Cheminformatics Specialist - Remote

Quincy, MA · Remote

$80 - $110/hr

No prior experience in AI is required -- your domain knowledge is what matters. Scope of Work ... Strong coding proficiency in Python (beyond analysis scripts), with hands-on experience building ...

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Remote Prior Authorization Representative Express Scripts information

What is the difference between Remote Prior Authorization Representative Express Scripts vs Remote Claims Processor?

AspectRemote Prior Authorization Representative Express ScriptsRemote Claims Processor
CredentialsHigh school diploma, healthcare certifications often preferredHigh school diploma, healthcare or insurance certifications
Work EnvironmentRemote, healthcare insurance settingRemote, insurance claims processing environment
Employer & IndustryExpress Scripts, healthcare/pharmacy industryVarious insurance companies, healthcare industry
Primary ResponsibilitiesReview and approve prior authorization requestsReview and process insurance claims

The Remote Prior Authorization Representative at Express Scripts focuses on evaluating and approving prior authorization requests for medications, ensuring timely patient access. In contrast, a Remote Claims Processor handles the review and processing of insurance claims after services are rendered. While both roles require healthcare knowledge and remote work skills, their core functions differ in the stages of the insurance process they manage.

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Remote Prior Authorization Representative Express Scripts jobs near you

Pharmacy Prior Authorization Specialist

Onco360

Waltham, MA • On-site, Remote

$22.25 - $29/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 14 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

19th of 112 rated pharmacies

Job description

Pharmacy Prior Authorization Specialist – Onco360 Pharmacy
Waltham, MA | Full-Time | Starting at $23.00/hr and up
Sign-On Bonus: $5,000 for employees starting before August 31, 2026!
Join a mission-driven team making a difference in the lives of cancer and rare disease patients.
Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Waltham, MA. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.
Why Join Us?
  • A career with purpose: Help patients access life-saving medications.
  • Supportive culture: We value teamwork, respect, integrity, and passion.
  • Growth opportunities: We invest in your professional and personal development.
Company Benefits
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Quarterly Incentive Bonus
  • Paid Volunteer Day
  • Referral Incentive Program
  • 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 from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
How You’ll Do This
  • Manage prior authorization requests and appeals with insurance carriers.
  • Collaborate with physicians, pharmacists, and other departments.
  • Ensure HIPAA compliance while handling sensitive patient information.
  • Maintain accurate documentation of authorization details.
  • Proactively monitor and renew expiring authorizations.
What You Bring
Required:
  • High School Diploma or GED
  • 1+ years of pharmacy or prior authorization experience
  • Registration with Board of Pharmacy (as required by state law)
  • Strong communication, organizational, and customer service skills
  • Self-motivated, organized, detail-oriented, and adaptable to changing priorities
  • Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
Preferred:
  • Associate degree or Certified Pharmacy Technician (PTCB)
  • 3+ years of experience in pharmacy or prior authorizations
  • Specialty pharmacy experience
Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.

What Onco360 employees say

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