Pharmacy Prior Authorization Coordinator I
$39,603–$65,998 year
Remote · Virginia Beach, Virginia, United States
Job Summary
Pharmacy Prior Authorization Coordinator I handles PA requests for pharmacy benefit medications, verifies member eligibility, communicates PA status to members and providers, and enters PA data into systems. The role reviews medication history, assesses formulary alternatives, and applies clinical guidelines to determine approvals, pendings, or referrals. It requires adherence to defined TATs and client performance standards, collaboration with internal teams and external stakeholders, and careful, compliant data handling. The position emphasizes high-quality customer service, accurate processing, and maintaining confidential PA information while meeting productivity and accuracy targets.
Required Qualifications
- High School Diploma or GED strongly preferred
- 1 year healthcare experience required
- Ability to verify member insurance eligibility and pharmacy benefit coverage
- Ability to communicate with members and providers regarding basic inquiries and PA status
- Accurate data entry and processing of PA requests
- Adherence to turnaround times and client performance guarantees
- Review medication history and assess formulary alternatives
- Document PA information clearly and accurately
- Maintain confidentiality and security of data
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