Prior Authorization Technician - Remote

3 days ago Be among the first 25 applicants

At Polaris Pharmacy Services, we’re more than a pharmacy — we’re a dedicated partner in care, transforming how patients experience long‑term, post‑acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we’re raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support.

The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing, eliminating financial risks for Polaris and its customers. The Specialist must be responsive and courteous when addressing customer needs, and dedicated to meeting expectations and requirements of the position.

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks.
• Research, analyze, and appropriately resolve rejected claims with national Medicare D plans, third‑party insurance companies, and state Medicaid plans, meeting critical deadlines.
• Ensure approval of claims by performing appropriate edits and/or reversals to maximize reimbursement.
• Contact providers and/or customers as necessary to obtain additional information.
• Monitor and resolve revenue at risk associated with payer setup, billing, rebilling, and reversal processes.
• Work as a team to identify, document, communicate, and resolve payer/billing trends and issues.
• Complete, communicate, and submit necessary payer paperwork, including prior authorization forms and manual billing, in a timely manner.
• Review and convert billing exception reports to ensure claims are billed to accurate financial plans.
• Complete billing transactions for non‑standard order entry situations as required.
• Support training needs.
• Prepare and maintain reports and records for processing.
• Perform other tasks as assigned.
• Follow applicable government regulations, including HIPAA.
• Comply with departmental policies regarding safety, attendance, and dress code.
• Overtime, holidays, and weekends may be required and/or expected.
• Conduct job responsibilities in accordance with the Company’s Code of Business Conduct and Ethics and applicable laws.
• Other duties as assigned; job duties may vary depending on business needs.

• High School diploma or equivalent required.
• Minimum of one (1) year working as a pharmacy technician in a retail environment; long‑term care pharmacy preferred.
• Framework LTC & General computer knowledge and 10‑key number entry preferred.
• Proficient in Microsoft Word, Excel, and Outlook.
• Customer service, results‑oriented, good organization and attention to detail.
• Basic computer and math skills; experience with alpha‑numeric data entry.
• Ability to read, write, speak, and understand English.
• Fast‑paced work ability and adaptability to an ever‑changing environment.
• Reliability and problem‑solving skills.
• Able to work various shifts and days.

• May sit or stand 7–10 hours per day.
• Occasionally required to sit, climb, balance, stoop, kneel, bend, crouch, walk, crawl intermittently.
• May be necessary to work extended hours as needed.
• May lift and/or move up to 50 pounds.

• Paid holidays: 6 days annually plus 5 sick days.
• Up to 10 PTO days per year with rollover options and milestone bonuses.
• Option to cash out up to 10 PTO hours each quarter.

• Medical, Dental, and Vision insurance.
• 401(k) (available for Part‑Time & Full‑Time employees).
• Company‑Paid Life insurance.
• Short‑term and Long‑term disability insurance.
• Tuition reimbursement.
• Personal Time Off (PTO).
• Competitive pay with annual performance reviews and merit‑based raises.
• Career growth potential.
• Annual on‑site voluntary flu vaccine.
• Employee referral bonus program.