Prior Authorization Specialist – Hybrid Role!!

Responsibilities:

• Contact pharmacy benefit managers (PBMs) and major medical plans to validate benefit verification requests.
• Communicate with physician offices to obtain current prescriptions and clinical documentation.
• Ensure documentation meets payer requirements and initiate prior authorizations via CoverMyMeds.
• Follow up on pending authorizations within 48 hours and respond to urgent requests from internal teams.
• Manage re-authorizations and submit approvals through the complex audit process.
• Track and process approvals, denials, and expiration timelines to ensure continuity of care.

what we are looking for:

• 1–3 years of experience in a pharmacy or healthcare setting
• Strong understanding of prior authorization processes, pharmacy benefits, and major medical insurance.
• HS Diploma or GED

Work Environment:

• Hybrid Schedule: Work 2 days on-site and 3 days remotely.
• Structured Training: 6–8 weeks of hands-on training tailored to your pace.
• Work-Life Balance: Monday–Friday, 9:30 AM–6:00 PM schedule.

Worksite Location

• 1111 Nicholas Blvd, Elk Grove Village, Illinois, 60007-2516, United States

If interested to discuss about the position, please contact:vsathyanarayan@actalentservices.com