NYX Health

Prior Authorization Specialist - Remote
Position Summary
We're looking for a driven, detail-oriented individual to join our team as a Prior Authorization Specialist. You'll receive training and ongoing support to set you up for success. As part of this role, you'll complete accurate insurance verifications and prior authorizations to ensure timely reimbursement. You'll also collaborate with clinicians and insurance payors in a fast-paced environment to manage claims, documentation, and approvals. If you enjoy problem-solving, staying organized, and making a meaningful impact-both independently and as part of a team-we'd love to hear from you.
Key Responsibilities

• Pharmacy Benefits PA Submissions
• Navigating EMR/PM systems for demographic information, patient clinical notes, and labs.
• Coordinate initial submission of prior authorization processes including preparation of PA, answering Prior Authorization clinical questions, submitting Pharmacy benefit PA's
• Utilize covermymeds to complete submission of Prior Authorizations
• Communicate with providers and insurance companies regarding authorization status.
• Maintain HIPAA compliance and support daily revenue cycle operations.
• Aprima experience+

Skills & Qualifications

• 3-5 years rheumatology medication PA experience is Required
• Specialty Pharmacy experience - Required
• 5+ years of prior authorization experience -Required
• Knowledge of rheumatology medications and biosimilars -Required
• Proficient in EMR systems, Covermymeds, ECW, NextGen Emrs
• Strong communication, problem-solving, and organizational skills.
• Detail-oriented, analytical, and able to multitask in a fast-paced environment.

Education & Experience

• High School Diploma required; additional education in business or healthcare preferred.
• Experience in prior authorization, utilization review, insurance verification, and EMR systems. [preferred]

Work Environment & Physical Requirements

• Remote position
• Prolonged computer use; ability to lift up to 15 lbs.

Job Type, Schedule & Compensation

• Full-time, Monday-Friday, 8-hour day shift.
• Pay: $21-$23 per hour, [With additional pay available for exceptional experience.]