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Remote Prior Authorization Representative Express Scripts Jobs in Texas

Addus Homecare

Reauthorization Specialist

Frisco, TX · Remote

$16.75 - $22.50/hr

This includes re-verifying client eligibility, monitor insurance lifetime caps and prior authorization periods. Schedule : Remote Mon-Fri 40 hours per week. >> We offer our team the best * Medical ...

Curative HR LLC

Specialty UM Pharmacist

Austin, TX · Remote

The pharmacist will perform prior authorization reviews to ensure appropriate, evidence-based use ... This is a REMOTE Position with RPh Licensure required in the state of residence. ESSENTIAL DUTIES ...

Curative HR LLC

Specialty UM Pharmacist

Austin, TX · Remote

The pharmacist will perform prior authorization reviews to ensure appropriate, evidence-based use ... This is a REMOTE Position with RPh Licensure required in the state of residence. ESSENTIAL DUTIES ...

Curative HR LLC

Specialty UM Pharmacist

Austin, TX · On-site +1

$130K - $150K/yr

The pharmacist will perform prior authorization reviews to ensure appropriate, evidence-based use ... This is a REMOTE Position with RPh Licensure required in the state of residence. ESSENTIAL DUTIES ...

Janus Health

Business Analyst

Dallas, TX · On-site +1

Responsibilities * Analyze prior authorization and claim status datasets to identify trends ... Physical Demands This job is operated in a professional remote or in-office environment. This job ...

ConnectMed360

Patient Support Case Manager

Houston, TX · On-site +1

Comprehensively understand the benefits investigation process, plan design, prior authorization ... scripts, guides and other communications for patients and HCPs. • Communicate with specialty ...

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All JobsRemote Prior Authorization Representative Express Scripts JobsRemote Prior Authorization Representative Express Scripts Jobs in Texas

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.

What are popular job titles related to Remote Prior Authorization Representative Express Scripts jobs in Texas? For Remote Prior Authorization Representative Express Scripts jobs in Texas, the most frequently searched job titles are:
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Infographic showing various Remote Prior Authorization Representative Express Scripts job openings in Texas as of June 2026, with employment types broken down into 71% Full Time, and 29% Part Time. Highlights an 100% Remote job distribution.
Reauthorization Specialist

Reauthorization Specialist

Addus Homecare

Frisco, TX • Remote

$16.75 - $22.50/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Addus HomeCare rating

6.0

Company rating: 6.0 out of 10

Based on 134 frontline employees who took The Breakroom Quiz

126th of 232 rated social care providers

Job description

Position Summary: The Reauthorization Specialist is responsible for managing all aspects of reauthorizations for client care. This includes re-verifying client eligibility, monitor insurance lifetime caps and prior authorization periods.

Schedule: Remote Mon-Fri 40 hours per week.

>> We offer our team the best <<

  • Medical, Dental and Vision Benefits
  • Continued Education
  • PTO Plan
  • Retirement Planning
  • Life Insurance
  • Employee discounts

Process Intake, Reauthorization and Payer Transfers.

  • Process new intakes and reauthorization by reviewing referrals.
  • Ensure all services are authorized within required time frame to prevent laps in care.
  • Monitor authorization start and end date to proactively manage renewals and prevent expirations.
  • Follow up on pending authorization and communicate updates to the branch.

Documentation and Data Entry

  • Accurately enter and update authorization detail in the system, ensuring all information align with payer approvals.
  • Maintain complete, compliant, and well-organized patient records.
  • Review documentation for accuracy and consistency prior to submission or scanning.
  • Scan, upload and index authorization documents into the appropriate system and a timely manner.

Payor Transfer and Coordination

  • Handle payer transfers, ensuring authorization are updated and aligned with the new payer requirements.
  • Verify coverage details and authorization rules during payer change to maintain uninterrupted services.

Expired Reports and Requesting Authorization

  • Manage expired authorization report, identify discrepancies and take corrective action.
  • Track and resolve authorization issues that may effect billing, scheduling , or services.
  • Communicate with branches regarding or pending authoriztion and require next step.

Branch Support and Communications

  • Providing guidance and support related to authorization, documents and intake process.
  • Respond to branch inquiries promptly and collaborate to resolve authorization or documents issues.
  • Communication clearly and professionally via email and internal systems keep all parties informed.

Quality Assurance and Compliance

  • Ensure all process comply with payor guidelines, company policies and regulatory standards.
  • Identify errors or discrepancies and take corrective action to maintain data integrity.
  • Support workflow efficiency by proactively addressing issues before they impact patient care or operations.

Key Strengths/Requirements in the Role

  • Strong attention to detail accuracy in documents and data entry.
  • Effective communication and collaborations with branch teams.
  • Ability to manage high volume of authorization and deadlines.
  • Proactive problems-solving to prevent service disruptions
  • High school diploma or GED equivalent, some college preferred
  • 1-2 years of recent experience working in a health care setting and insurance authorizations
  • Excellent written and oral communication skills
  • Excellent customer service skills
  • Must be computer literate and possesses knowledge of computer software, Microsoft Excel (advance skills preferred), internet, Word and Outlook
  • Dependable, conscientious and reliable
  • Ability to analyze and interpret situations to complete tasks or duties assigned

To apply via text, text 11244 to 334-518-4376

Employee wellbeing is top priority at Addus Homecare, and we're thrilled to announce our recognition as the top healthcare company on Indeed's 2024 Top 100 Work Wellbeing Index. View the full rankings here: https://www.indeed.com/employers/work-wellbeing/work-wellbeing-100-ranking.

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