Prior Authorization Specialist - 246181 at Medix

We are seeking an energetic, detail-oriented Prior Authorization Specialist to join our team and play a key role in helping patients access life-changing specialty medications. If you're passionate about patient care and experienced in the specialty pharmacy ecosystem, we want to hear from you!

This role is 100% onsite and focused on supporting healthcare providers through the prior authorization (PA) process - from benefit verification to successful submission and follow-up.

• Job Opening: Prior Authorization Specialist
• Location: Onsite - Strip District, Pittsburgh, PA
• Pay: $22/hour
• Schedule: Monday - Friday, 40 hours/week
• Start Date Requirement: Must be available to work on January 1, 2026 (no exceptions). Ideally looking for someone on the sooner side.
• Shift Flexibility: Between 8:00 AM and 6:00 PM (standard 8-hour shift within this window)

Key Responsibilities:

• Communicate with prescriber offices to facilitate all steps of the PA process (via phone, chat, and email)
• Use various technology platforms to gather, submit, and track prior authorization cases
• Conduct benefit verification and navigate insurance requirements for both pharmacy and medical benefits
• Assemble complete case files using clinical documentation like chart notes, lab results, and medication histories
• Troubleshoot and follow up with payers until a final determination is reached
• Collaborate with internal teams to ensure process efficiency and patient-first outcomes

Required Background & Experience:

• Minimum 2 years of specialty pharmacy experience with a focus on prior authorization and benefit verification
• Strong understanding of drug names, medical terminology, and insurance workflows
• Excellent verbal and written communication and customer service skills
• Comfortable using evolving technologies and general computer proficiency

Preferred Skills & Competencies:

• Highly organized and detail-oriented
• Strong time management and prioritization abilities
• Critical thinking and independent problem-solving skills
• Able to work independently while contributing positively to a collaborative team environment

What You'll Be Doing (Day-to-Day):

Think of this role as being the engine of the authorization process. You’ll be the go-to expert who quarterbacks each case from start to finish:

1. Investigate: Start each case with a detailed benefit verification to identify insurance requirements
2. Communicate & Gather: Reach out to providers to collect necessary documentation
3. Assemble & Submit: Compile “clean” cases and submit through payer portals
4. Follow-Up & Troubleshoot: Proactively track submissions and resolve issues until final determination

Why Join Us?

• Help real patients get the treatments they need
• Be part of a mission-driven, solutions-focused team
• Work in a vibrant part of Pittsburgh’s Strip District
• Stable full-time hours with a competitive hourly wage

Ready to Apply?

If you're experienced, motivated, and ready to make a difference in patient care, we'd love to hear from you. Apply today!