Prior Authorization Specialist

Work Setup: 100% Onsite (Office location in either Eastwood, Clark or Muntinlupa)

Work Schedule: Night Shift (Following U.S. Time Zone)

Duties and Responsibilities:

The Pharmacy Prior Authorization Specialist is responsible for handling and processing medication prior authorization (PA) requests with minimal patient interaction. This role involves coordinating with physicians, pharmacies, and insurance providers to ensure timely and accurate submission of PA documentation. A strong understanding of insurance processes, medication coverage guidelines, and bio-similar medications is essential for success in this role.

• Process and submit electronic prior authorization (ePA) requests for medications.
• Communicate with physicians, pharmacy staff, and insurance companies regarding PA requirements and status updates.
• Use platforms such as CoverMyMeds to complete and track prior authorization requests.
• Interpret and apply insurance policies, formulary guidelines, and coverage rules.
• Review medication classifications, including bio-similar vs. brand-name products, to determine appropriate PA documentation.
• Determine when to discontinue PA efforts based on coverage likelihood and workflow guidelines.
• Manage denials appropriately (no appeals or extensive pushback required within this role).
• Maintain accurate and compliant documentation throughout the PA process.
• Follow internal procedures to avoid unnecessary appeals and ensure efficient workflow.

Job Requirements:

• Pharmacy Knowledge: Understanding of medication names, dosing, therapeutic classes, and basic clinical terminology.
• Insurance & Coverage Literacy: Familiarity with insurance plans, formulary processes, and pharmacy benefit structures.
• Attention to Detail: Ability to follow structured workflows accurately and avoid errors in documentation.
• Systems Proficiency: Experience using CoverMyMeds, EMR/EHR systems, pharmacy software, or insurance authorization platforms.
• Communication Skills: Clear and professional communication with clinical teams and pharmacy staff.
• Judgment & Decision-Making: Ability to assess when to continue or discontinue PA processing based on guidelines.
• Time Management: Efficiently manage multiple PA requests and deadlines.
• Process-Oriented: Comfortable working in a structured environment with defined procedures.

About Intelassist

Established in 2007, Intelassist is a remote staffing organization that originated from a collaboration between US-based industry professionals and an experienced operational team in Manila, Philippines. Our US team brings over 20 years of experience in engineering, manufacturing, IT, finance, and high-level operations, while our Manila-based team offers over 15 years of experience in delivering exceptional support to global enterprises.

Our coast-to-coast US offices, in collaboration with our dedicated employees in the Philippines, enable us to deliver results to clients in various markets and for a wide range of roles. With over 15 years of experience in the BPO industry, Intelassist places a strong emphasis on organizational resilience and social stewardship to foster lasting, meaningful partnerships within our team and with our clients.

At the core of our business lie our people. Our ability to recruit, train, and, most importantly, retain exceptional team members is not only what enables Intelassist to attract the region's finest talent but also what bestows stability upon our clients through reduced turnover and tangible outcomes.

With a workforce of slightly over 1,000 employees, we strike a balance – substantial enough to possess profound insight into the Business Process Outsourcing (BPO) industry, yet intimate enough to maintain the family-like, high-energy work atmosphere that our candidates seek.

At Intelassist, we specialize in sourcing, training, and retaining top-tier talent, each exclusively dedicated to meeting our clients' unique needs. Our proven track record and local presence ensure that Intelassist clients enjoy increased productivity, reduced staff turnover, and significant cost savings

WHY INTELASSIST?We grow together. We value your effort. We aim to empower you.