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Prior Authorizations Representative (Hybrid)

Addison Group • Contract • Elk Grove Village, Illinois, United States • 5d ago

Job Title: Prior Authorizations Representative (Hybrid)

Location (city, state): Elk Grove Village, IL

Compensation: $21 – $24 / hour (depending on experience)

Benefits: This position is eligible for medical, dental, vision, and 401(k).

Industry: Specialty Pharmacy / Healthcare Administration

Work Schedule: Monday–Friday, 8:00 AM – 5:00 PM CST; hybrid schedule (2–3 days onsite).

About Our Client:

Our client is a fast-growing specialty pharmacy dedicated to improving access to advanced therapies and rare disease treatments. They partner closely with providers, payers, and patients to ensure compassionate, thorough care and streamlined access to necessary medications.

Job Description:

Addison Group is seeking a Prior Authorizations Representative for our client in the specialty pharmacy field. This contract role runs through March 2026 and offers a hybrid work schedule, with 2–3 days per week onsite. The representative will work alongside the benefits verification team to validate patient insurance coverage, prescriptions, and clinical documentation to ensure timely prior authorization approvals.

Qualifications:

Minimum 2 years’ experience in a home infusion or specialty pharmacy setting (required).
At least 2 years of experience with both major medical and pharmacy insurance benefit verification.
Knowledge of commercial, Medicaid, and some Medicare plans.
Familiarity with HCPC and ICD-10 codes, H&P, genetic testing, and prescription reading.
Skilled in converting prescriptions into authorization requests based on payer requirements.
Proficient with insurance portals such as CoverMyMeds, Availity, and other payer systems.
Strong attention to detail, ability to multitask, and pride in accuracy.
Professional communication skills for interacting with multiple departments and physician offices.

Key Responsibilities:

Contact medical and pharmacy benefit plans to validate prior authorization requests.
Communicate with physician offices to obtain prescriptions and required clinical documentation.
Verify that submitted clinical documentation meets insurance plan requirements.
Initiate prior authorizations via CoverMyMeds and other payer portals.
Follow up on pending authorizations within 48 hours.
Respond to urgent authorization-related emails from patient care teams or program managers.
Obtain and file approval or denial letters.
Process complex and re-authorization requests according to internal audit protocols.
Proactively initiate re-authorizations 30 days before expiration dates.

Perks:

Hybrid schedule with free onsite parking.
Opportunity to work with a highly respected specialty pharmacy team.
Long-term contract stability through March 2026.

Additional Details:

This is a contract position; permanent hire is not anticipated at this time.
Training includes peer shadowing, one-on-one manager meetings, and knowledge checks to ensure accuracy.
Software exposure may include CareTend, CPR+, FastTrack, and various insurance portals.
Dress code is business casual when onsite or on camera.

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.

IND 004-008

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