Job Description

Authorization Support Specialist

At CSI Pharmacy (CSI), we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care.

CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission.

The Authorization Support Specialist plays a critical role in supporting the Prior Authorization (PA) workflow by ensuring timely follow-up, accurate documentation, and effective communication with insurance payers and internal clinical teams. This position is primarily responsible for contacting insurance companies to obtain status updates on submitted prior authorizations, entering approval and denial documentation into CareTend, and reviewing denial outcomes prior to escalation to the Clinical Utilization Team for further review. The Authorization Support Specialist helps ensure continuity of care, reduces authorization delays, and supports compliance with payer and operational requirements.

Location: Plano, TX

Schedule: Monday Friday; 8:30am 5:00pm (100% On-Site)

Essential Duties and Responsibilities

Include the following. Other duties may be assigned as necessary.

• Prior Authorization Status Follow-Up: Proactively contact insurance companies via phone, portals, or fax to obtain real-time status updates on submitted prior authorization requests.
• Documentation & Data Entry: Accurately enter PA approval letters, authorization numbers, effective dates, and related documentation into CareTend and other applicable systems.
• Denial Review & Routing: Review PA denial letters for completeness and clarity, ensuring all required documentation is captured before forwarding cases to the Clinical Utilization Team for clinical review and appeal determination.
• Queue & Workflow Management: Monitor assigned PA work queues to ensure timely follow-up and prevent delays in patient therapy initiation or continuation.
• Payer Communication & Tracking: Maintain detailed notes of payer interactions, including call outcomes, reference numbers, and next steps, in accordance with internal documentation standards.
• Collaboration with Internal Teams: Communicate authorization outcomes and issues with Pharmacy Operations, Clinical Utilization, and Revenue Cycle teams to support coordinated patient care.
• Compliance & Accuracy: Ensure all authorization activities comply with payer requirements, internal policies, and regulatory standards.
• Continuous Improvement Support: Identify recurring payer issues, trends in denials, or process inefficiencies and escalate insights to leadership as appropriate.

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Detail Orientation: High level of accuracy in data entry and the ability to identify specific details within complex insurance documents.
• Communication Skills: Strong verbal communication skills for professional interaction with insurance representatives and internal clinical staff.
• Technical Proficiency: Ability to navigate complex healthcare software systems and insurance portals; experience with CareTend is a significant advantage.
• Time Management: Ability to manage a high volume of pending authorizations and prioritize follow-ups based on urgency and patient need.

Education and/or Experience

• Educational Background: A High School Diploma or equivalent is required.
• Experience: A minimum of 12 years of experience in healthcare administrative support, pharmacy billing, or medical insurance verification.
• Technical Experience: Previous experience working with Prior Authorizations (PA) and familiarity with medical terminology or pharmacy workflow is highly preferred.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

CSI Pharmacy is an Equal Opportunity Employer

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