Prior Authorization Technician - Remote

PRIOR AUTHORIZATION SPECIALIST (REMOTE)

WHO WE ARE
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.

 Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job — we provide competitive pay, robust benefits, and genuine opportunities for career advancement.

If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us.

OVERVIEW

The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. The Prior Authorization Specialist must be responsive and courteous when addressing our customers needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers trust and respect.

RESPONSIBILITIES

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers
• Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
• Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
• Contact providers and/or customers as necessary to obtain additional information
• Monitor and resolve revenue at risk associated with payer set up, 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 but not limited to prior authorizations forms and manual billing in a timely manner
• Review and work 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 all 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 standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
• Other duties as assigned; Job duties may vary depending on business needs

QUALIFICATIONS