Senior Prior Authorization Specialist

We’re hiring a highly experienced Prior Authorization (PA) & Verification Specialist to manage end-to-end PA workflows for a US retail pharmacy (Simplex Pharmacy). This is a senior role for a candidate who already knows US payers/PBMs, ePA tools and retail pharmacy systems - minimal training time required.

Why Join Us:

Work directly with an NYC pharmacy team - high-impact role that prevents revenue loss and improves patient access.

Remote, professional environment with clear processes and stable EST schedule.

Competitive market pay for senior candidates (see below).

Key Responsibilities:

Manage end-to-end prior authorization workflows (identify PA triggers, prepare & submit PA requests, attach clinical docs).

Verify patient insurance, benefits, formularies, copays and document eligibility.

Use ePA portals (CoverMyMeds / Surescripts) and PBM/payer web portals to submit & track requests.

Persistent follow-up and tracking; document outcomes and authorization numbers.

Handle denials — prepare appeals, run peer-to-peer discussions and coordinate physician documentation.

Maintain accurate records in pharmacy EHR / dispensing software.

Provide clear communication to prescribers, patients and internal pharmacy staff.

Suggest process improvements and prepare PA submission templates/checklists.

Maintain HIPAA-compliant practices at all times.

Must-Have (non-negotiable):

Direct experience working with US payers / PBMs (e.g., CVS Caremark, Express Scripts, OptumRx, UnitedHealthcare).

Hands-on use of electronic PA (ePA) portals like CoverMyMeds or Surescripts.

Experience with US retail pharmacy systems (PioneerRx, Rx30, QS/1 or similar).

Proven track record with denials & appeals (including Medicare Part D appeals knowledge).

Excellent spoken & written English — comfortable with phone-based peer-to-peer calls.

Able to work 9:00 AM–5:00 PM EST (full-time, exclusive commitment preferred).

Reliable remote setup (secure workspace, VPN if required) and readiness to comply with HIPAA.

Nice-To-Have:

Prior experience with pharmacy billing/RCM, claims codes (CO, PR denial codes), or prior authorization certifications.

Background in pharmacy or clinical training.

Salary:

PKR 200,000 - 350,000+ / month depending on experience & proven appeals success. (Offer competitively to secure top 5% talent.)

Job Skills

Insurance Verification & Benefits InvestigationAutonomy & Self-ManagementProactive Stakeholder CollaborationProblem-Solving & Critical ThinkingTechnical Proficiency (ePA & EMREHR Systems)End-to-End Process OwnershipPersuasive Communication & AdvocacyDenial & Clinical Appeals ManagementExpert-Level U.S. Payer & PBM Knowledge

Job Details

Industry:

Information Technology

Functional Area:

Sales & Business Development

Total Positions:

1 Post

Job Shift:

First Shift (Day)

Job Type:

Full Time/Permanent

Job Location:

Islamabad, Karachi, Lahore, Rawalpindi, Pakistan

Gender

No Preference

Minimum Education

Master

Career Level

Experienced Professional

Minimum Experience

5 Years

Apply Before:

Dec 04, 2025

Posting Date:

Nov 03, 2025