Pharmacy Prior Authorization Specialist

2 days ago

Quezon City, National Capital Region, Philippines Intelassist Full time ₱250,000 - ₱450,000 per year

EOR: One Workforce Global
Employment Type: Full-Time Employment
Work Setup: 100% Onsite (Office location in either Eastwood, Clark or Muntinlupa)
Work Schedule: Night Shift (Following U.S. Time Zone)

Position Overview:

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.

Duties and Responsibilities:

  • 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.

WHY INTELASSIST?
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