Prior Authorization Assistant - Pharmacy

Ascertain

1d

About The Position

This is a hands-on role for someone who thrives in high-volume operational environments and is comfortable balancing individual contribution with team support.
You will continue to process prior authorizations directly—often at high volume—while also serving as a go-to resource for other Ascertain Assistants. Over time, this role will evolve into a hybrid operations + technology position as workflows become increasingly automated and integrated with Ascertain’s platform.
This is not a traditional healthcare shift-based, desk role. It is an outcome-driven position that rewards ownership, judgment, and follow-through.
As a Prior Authorization Assistant at Ascertain, you will play a critical role in our new AI-powered prior authorization solution. You’ll collaborate directly with Ascertain leadership and product teams, helping to shape how prior authorization is transformed through recent advances in artificial intelligence. This is a unique opportunity to work at the intersection of healthcare operations and cutting-edge technology.
You’ll work closely with healthcare providers to reduce administrative burdens and streamline detailed workflows. Day-to-day, this includes manually processing authorizations and overseeing automated submissions for office visit referrals, procedures, pharmaceuticals, and more. The role offers broad exposure to multiple healthcare specialties, external stakeholders, and departments across Ascertain.

Requirements

• 4+ years of experience with prior authorization and billing in multiple specialties, including 2+ years of direct pharmacy prior authorizations experience.
• Experience handling denials and the appeals and peer to peer process
• Strong understanding of formularies, step therapy, and medication coverage policies
• Familiarity working with different specialty pharmacies and online portals
• Detail-Oriented. You are meticulous in your work, catching errors and ensuring every authorization is processed accurately the first time.
• Collaborative. You are energized by working with others, building trust and communicating clearly with providers, teammates, and cross-functional stakeholders.
• Adaptable. You are comfortable shifting between manual workflows and leveraging new AI-powered tools, adjusting quickly as processes evolve.
• Empathetic. You are attuned to the needs of healthcare providers and patients, approaching each interaction with patience, professionalism, and understanding.
• Process-Driven. You are motivated by structure and consistency, following established workflows while identifying opportunities for improvement.

Nice To Haves

• client relationships
• hands-on leadership roles (e.g., Team Lead, Supervisor, or informal leadership), paired with a roll-up-your-sleeves approach
• engaging with C-suite executives.

Responsibilities

• Review and verify insurance information and patient eligibility for prior authorizations for prescription medications.
• Work directly with insurance payers, PBMs, and pharmacy benefit plans
• Interpret formularies, step therapy requirements, quantity limits, and coverage criteria
• Communicate with healthcare providers to gather necessary medical documentation and information.
• Monitor and track authorization requests to ensure timely processing and resolution.
• Respond to inquiries from healthcare providers, patients, and insurance companies regarding authorization status.
• Maintain accurate records of authorization requests, approvals, and denials.
• Collaborate with internal teams to resolve authorization issues and improve process efficiency.
• Stay updated on insurance policies, regulations, and industry trends related to prior authorizations.

Benefits

• Make a real difference: Your work will directly impact healthcare organizations and improve patient care.
• Join Ascertain in transforming healthcare with AI!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed