A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Pharmacy Prior Authorization Specialist - Onco360 Pharmacy Houston, TX | Full-Time | Starting at $23.00/hr and up
Sign-On Bonus:
$5,000 for employees starting before September 30, 2026! Join a mission-driven team making a difference in the lives of cancer patients. Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training. Why Join Us?
A career with purpose:
Help patients access life-saving medications.
Supportive culture:
We value teamwork, respect, integrity, and passion .
Growth opportunities:
We invest in your professional and personal development. Company Benefits Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Quarterly Incentive Bonus Paid Volunteer Day Referral Incentive Program Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests. How You'll Do This Manage prior authorization requests and appeals with insurance carriers. Collaborate with physicians, pharmacists, and other departments. Ensure HIPAA compliance while handling sensitive patient information. Maintain accurate documentation of authorization details. Proactively monitor and renew expiring authorizations.
What You Bring Required:
High School Diploma or GED 1+ years of pharmacy or prior authorization experience Registration with Board of Pharmacy (as required by state law) Strong communication, organizational, and customer service skills Self-motivated, organized, detail-oriented, and adaptable to changing priorities Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with
CoverMyMeds Preferred:
Associate degree or Certified Pharmacy Technician (PTCB) 3+ years of experience in pharmacy or prior authorizations Specialty pharmacy experience Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer. #
