Prior Authorization Specialist
LOCATION: Cary, NC – 11800 Weston Parkway, Cary, NC 27513 | Onsite
COMPENSATION & SCHEDULE
• Pay Range: $20.00 – $25.00 / hour (candidates must meet specific qualification criteria to start at the $25 rate)
• Hours: Monday – Friday, 9:30 AM – 6:30 PM EST (1-hour unpaid lunch)
ROLE IMPACT : You will ensure patients receive timely coverage by managing the full prior authorization lifecycle: collecting clinical documentation, submitting authorizations and appeals, following up until resolution. Success is measured by speed, accuracy, and maintaining professional communication across all interactions with patients, providers, manufacturers, and payors.
KEY RESPONSIBILITIES
• Respond to inbound calls and place outbound calls with patients, providers, manufacturers, and insurance companies to manage prior authorization requests.
• Acquire, review, and submit required clinical documentation as per each insurance’s process and follow up until authorization or appeal resolution.
• Maintain accurate case records per standard operating procedures, ensuring attention to detail in documentation and process.
• Collaborate with team members and leadership; communicate status updates, changes, and escalate issues as needed.
• Learn and use the pharmacy management system for processing pharmacy claims.
MINIMUM QUALIFICATIONS
• Proven experience in prior authorization work, including clinical documentation submission, appeals, or external reviews.
• Strong communication, customer service, and critical thinking skills. Professional manner required when dealing with all stakeholders.
• Ability to document accurate progress notes on ~25-30 calls per day.
• Basic computer skills, including Microsoft Outlook and Teams.
QUALIFICATIONS FOR $25/HOUR RATE (Premium Criteria)
• Active CPhT certification.
• 3+ years of prior authorization experience (clinical documentation, submitting authorizations, appeals, external reviews).
• 1+ year experience in a retail pharmacy setting (familiarity with claim adjudication).
IDEAL TRAITS & SOFT SKILLS
• Independent and self-motivated; able to adapt to changing assignments or priorities.
• Compassionate toward patients; respectful team player.
• High attention to detail; organized.
PERKS & ADVANCEMENT
• Cross-training across all aspects of Skyclarys to become a Subject Matter Expert.
• Potential conversion to Full Time Employee (FTE) depending on performance and headcount.
LEGAL NOTICE
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