Required Education• High School Diploma or equivalent. Required Qualifications / Skills / Experience• Previous medical insurance experience• Prior authorization experience• Data entry experience• Strong attention to detail and accuracy• Ability to work in a fast-paced production environment• Experience using multiple software applications simultaneously• Ability to meet productivity, quality, and turnaround time requirements• Strong organizational and documentation skills• Ability to learn and apply changing Medicare Part D guidance• Strong written and verbal communication skills• Ability to work rotating schedules, weekends, and holiday coverage as needed• Reliable high-speed internet connection• Ability to participate on camera during training, supervisor meetings, and team meetingsPreferred Qualifications / Skills / Experience• Medicare experience• Healthcare operations experience• Fax queue processing experienceMedicare Prior Authorization Specialist Overview• Supports Medicare coverage determination and appeals operations through accurate review and routing of incoming documentation• Reviews faxed documents and ensures cases are directed to the appropriate processing queues• Utilizes multiple software systems to create and maintain Medicare prior authorization case reviews• Maintains complete, accurate, and timely documentation for all case activity• Works within government-mandated turnaround times and productivity standards• Researches reports and escalates issues to pharmacists or management when appropriate• Maintains knowledge of evolving Medicare Part D regulations and operational procedures• Supports business needs through schedule flexibility, including rotating weekends and holiday coverage• Participates in ongoing training, coaching, and developmental discussions• Contributes to operational excellence through quality-focused case handling and documentation accuracyJob Duties • Review incoming fax documents and route to appropriate work queues• Create Medicare prior authorization case reviews using multiple systems• Maintain accurate documentation of coverage determination and appeal requests• Research reports and case information as needed• Escalate issues to pharmacists or management when appropriate• Meet government-mandated turnaround times• Meet productivity and quality expectations• Maintain current knowledge of Medicare Part D guidance and regulations• Participate in training, coaching, and performance feedback sessions• Provide assistance and guidance when requested• Support business operations during weekends and holiday rotations**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.**