Prior Authorization Intake Representative-Remote

Required Education:• High School Diploma or Equivalent Diploma Preferred Education:• Associate Degree or Bachelor’s Degree Required Qualifications/Skills/Experience:• 1–3 years of related experience in Prior Authorization, data entry, or customer service

• Basic computer skills
• Proficiency with Microsoft Excel and Word
• Strong keyboard skills
• Ability to multitask and navigate multiple system applications simultaneously
• Basic pharmaceutical knowledge, including terminology, calculations, and protocols
• Strong attention to detail
• Excellent verbal and written communication and interpersonal skills
• Ability to maintain patient confidentiality
• Ability to work in a high-pressure, time-sensitive environment
• Strong organizational and telephone skills
• Ability to read and understand pharmacy and medical terminology
• Ability to follow directions and adapt to changing priorities
• Ability to consistently meet quality and production standards Preferred Qualifications/Skills/Experience:• Prior Authorization experience
• Healthcare industry experience
• High-volume call center experience
• Remote work experience
• Ability to work independently and utilize available resources
• Experience maintaining confidentiality of Protected Health Information (PHI)
• Strong problem-solving skills and demonstrated sense of urgency
• Ability to anticipate needs and resolve issues promptly
• Ability to learn and understand complex material
• Intellectual curiosity and willingness to ask questions to develop a deep understanding of the business
• Experience with Microsoft Access, Outlook, PowerPoint, or Visio Prior Authorization Intake Representative – Remote Overview:• The Prior Authorization Intake Representative – Remote provides professional and courteous phone support to providers, pharmacies, members, and other callers throughout the criteria-based Prior Authorization process• The role is responsible for maintaining complete, timely, and accurate documentation of reviews while transferring clinical questions, escalations, and judgment calls to the pharmacist team• The representative may also handle outbound calls, review and process Prior Authorization requests received through fax and electronic Prior Authorization (ePA), and monitor and respond to inquiries through department mailboxes• The position requires strong attention to detail, excellent communication and telephone skills, the ability to multitask across multiple applications, and the ability to work effectively in a high-pressure, time-sensitive environment• Candidates must be able to understand pharmacy and medical terminology, maintain patient confidentiality, adapt to changing workflows, and consistently meet quality and production standards. This is a fully remote position requiring a private, HIPAA-compliant workspace, hardwired internet, and the ability to work on a computer throughout the assigned shiftJob Duties:• Handle high-volume inbound calls from providers, pharmacies, members, and other callers
• Provide professional and courteous phone assistance throughout the criteria-based Prior Authorization process
• Maintain complete, timely, and accurate documentation of reviews and requests
• Transfer clinical questions, escalations, and judgment calls to the pharmacist team
• Make outbound calls as needed
• Review and process Prior Authorization requests received through fax and ePA
• Monitor and respond to inquiries through department mailboxes
• Navigate multiple system applications simultaneously
• Follow established procedures, work instructions, and quality standards
• Perform additional duties as assigned by the leadership team Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.