Competitive Pay | Stable Schedule | Career Growth

Our Company:

SpecialtyRx is a Long-Term Care pharmacy providing pharmaceutical services to long-term care facilities, assisted living communities, and hospice providers. SpecialtyRx takes pride in delivering personalized care and quality pharmacy services to the residents and communities we serve.

Position: Prior Authorization & Insurance Billing Specialist

Position Summary:

We are seeking a detail-oriented and organized Prior Authorization & Insurance Billing Specialist to join our Long-Term Care Pharmacy Billing Department in Illinois. This position plays a critical role in researching insurance coverage, processing prior authorizations, resolving insurance rejections, and ensuring accurate patient billing information.

The ideal candidate has experience with pharmacy insurance billing, prior authorizations, and insurance eligibility research, with a strong understanding of retail pharmacy claims and a preference for long-term care pharmacy experience. Experience with hospice billing and insurance coordination is a plus.

This individual must be comfortable communicating with insurance providers, client facilities, and internal departments while managing multiple tasks in a fast-paced, deadline-driven environment.

Responsibilities:

Perform duties and additional tasks as assigned by the Billing Supervisor.
Research and verify patient eligibility and insurance coverage through state-sponsored and private insurance providers.
Submit and follow up on prior authorization requests for state insurance plans and other applicable payers.
Review daily insurance rejection reports, determine the cause of rejections, and take appropriate action to resolve them.
Research and process insurance rejections, overrides, and claim issues to support timely and accurate prescription billing.
Maintain and update patient billing information, insurance details, and eligibility records in the pharmacy management system.
Communicate with insurance companies daily regarding prior authorizations, overrides, rejected claims, coverage changes, and eligibility updates.
Coordinate with client facility staff and applicable insurance and government program representatives to resolve billing and coverage issues.
Assist with insurance research and billing coordination for hospice patients, including verifying coverage and helping resolve payer-related issues.
Assist client facilities with medication pricing inquiries and provide accurate price quotes when requested.
Follow up on pending prior authorizations, rejected claims, and unresolved billing issues to ensure timely resolution.
Perform monthly patient census reviews and reconcile patient information to support accurate billing.
Maintain accurate documentation of insurance research, authorization submissions, claim follow-ups, and billing communications.
Work collaboratively with pharmacy operations, billing, and other internal teams to ensure continuity of service and accurate reimbursement.
Follow established billing procedures and applicable payer requirements, privacy standards, and pharmacy policies.
Perform other duties as assigned by management.

Qualifications:

High School Diploma or GED required.
Current Pharmacy Technician Certification Board (PTCB) certification preferred or required, depending on the position's responsibilities and applicable requirements.
Previous retail pharmacy experience required.
Experience with pharmacy insurance billing, prior authorizations, and insurance eligibility research preferred.
Long-term care pharmacy experience preferred.
Experience with New York pharmacy billing claims preferred.
Hospice billing or hospice medication coverage experience is a plus.
Familiarity with state insurance programs, private insurance plans, Medicare Part D, and pharmacy claim rejection codes preferred.
Understanding of insurance overrides, coverage restrictions, and prior authorization processes.
Basic proficiency in Microsoft Office and pharmacy management or billing systems.
Strong attention to detail and the ability to research, analyze, and resolve billing discrepancies.
Excellent telephone etiquette and professional communication skills.
Strong organizational and time-management skills, with the ability to manage multiple priorities and deadlines.
Ability to work independently and collaborate effectively with a team.
Ability to work nights and weekends as required by departmental scheduling.
Dependable, proactive, and committed to maintaining accurate patient and billing records.

What We Offer:

Competitive pay based on experience.
Consistent scheduling based on departmental needs.
Health, dental, and vision insurance.
Group Life Insurance and Short-Term Disability.
Paid time off and paid holidays.
401(k) with company match.
Training and opportunities for professional development.
Career advancement opportunities within SpecialtyRx.

Equal Employment Opportunity (EEO) Statement:

SpecialtyRx, Inc. is committed to employing a diverse workforce. We recruit and retain talented individuals without regard to race, color, religion, sex, gender, age, national origin, marital status, disability, veteran status, sexual orientation, gender identity, or any other status protected by applicable federal, state, or local law, including the Illinois Human Rights Act.

EO/Minorities/Females/Disabled/Veterans.

About SpecialtyRx:

SpecialtyRx is proud to be a beacon for inclusion, collaboration, and diversity. Everyone cares in the same language, and we draw from each community to be for each community.

SpecialtyRx

Pharmacy Prior Authorization Billing Technician

About the Job