Job Description

Job Title: Complex Prior Authorizations Representative

Location: Elk Grove Village, IL (Hybrid 2-3 Days onsite per week)

Industry: Specialty Pharmacy / Healthcare

Compensation: $21 - $24 / Hr

Benefits: This position is eligible for Medical, Dental, Vision, and 401K benefits.

Work Schedule: Monday - Friday 8am - 5pm

About Our Client:

Our client is a growing specialty pharmacy organization focused on supporting patients with complex and high-cost therapies. They partner closely with healthcare providers and insurance payors to ensure timely access to treatment while maintaining a high standard of accuracy and compliance.

Job Description:

Addison Group is hiring a Complex Prior Authorizations Representative to support a year-end project for our client. This full-time, hybrid contract role will work closely with benefits verification and patient care teams to manage complex prior authorization requests. The ideal candidate has strong experience within a pharmacy environment and is comfortable navigating medical and pharmacy benefits, insurance portals, and payer-specific authorization requirements.

Key Responsibilities:

• Communicate with commercial and government insurance plans to validate authorization requests
• Partner with physician offices to confirm prescriptions and gather required clinical documentation
• Review submitted clinical records to ensure alignment with payer guidelines
• Initiate and manage prior authorizations using payer portals and CoverMyMeds
• Track and follow up on pending authorizations within established turnaround times
• Respond to time-sensitive inquiries from internal care teams and leadership
• Secure approval and denial documentation from payors
• Submit completed complex authorizations through internal audit workflows
• Proactively initiate re-authorizations prior to expiration dates

Qualifications:

• Minimum 2 years of experience within a pharmacy or specialty pharmacy setting (required)
• At least 2 years of experience working with both medical and pharmacy benefits
• Working knowledge of commercial insurance, Medicaid, and limited Medicare plans
• Familiarity with payer portals, insurance cards, medical policies, and authorization workflows
• Experience using tools such as CoverMyMeds and Availity
• Understanding of HCPCS codes, ICD-10 codes, and prescription review
• Ability to translate prescriptions into authorization requests based on payer requirements
• Exposure to H&P documentation and genetic testing is a plus

Perks:

• Hybrid work schedule
• Free onsite parking
• Structured onboarding with peer-to-peer training
• Ongoing one-on-one support and performance check-ins
• Opportunity to contribute to high-impact, patient-focused work

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. Reasonable accommodations are available for qualified individuals with disabilities upon request.

IND 004-008

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