Prior Authorization Specialist

4 weeks ago


Newton, Massachusetts, United States Orsini Specialty Pharmacy Full time
About Orsini Specialty Pharmacy

We are a leader in rare disease and gene therapy pharmacy solutions, dedicated to providing compassionate care to patients and their families.

Our Mission

We are committed to being the essential partner for biopharma innovators, healthcare providers, and payors to support patients in accessing revolutionary treatments for rare diseases.

LIVE IT Values

Our core values of Leading Quality, Integrity, Valued Partner, Empathy, Innovation, and Team-First drive our commitment to excellence, collaboration, and genuine care in every aspect of our work.

Job Summary

This role will work closely with the Benefits Verification Team to validate patient insurance plans, prescriptions, and eligibility. The successful candidate will have excellent communication skills and be able to read prescriptions, convert prescriptions into authorizations, and interpret medical policies.

Key Responsibilities
  1. Contact plans (PBM or Major Medical) to validate requests sent from BV
  2. Contact physician's offices to obtain current prescriptions and clinical documentation
  3. Validate clinical documentation received and initiate prior authorizations through Cover My Meds
  4. Follow up on all pending PA's within 48 hours and respond to urgent emails in a timely manner
  5. Obtain approval/denial letters and submit new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process
  6. Initiate re-authorizations that are set to expire 30 days prior to the term date
Employee Benefits

We offer a comprehensive benefits package, including BCBSL Medical, Delta Dental, EyeMed Vision, 401k, Accident & Critical Illness, Life Insurance, PTO, Holiday Pay, and Floating Holidays, as well as Tuition Reimbursement.



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