Polaris Pharmacy Services
Overview
At Polaris Pharmacy Services, we’re a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. We are industry leaders raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support. Polaris was founded in 2015 and is locally and independently owned, with a growing national footprint. We offer competitive pay, robust benefits, and opportunities for career advancement. If you’re passionate about shaping the future of pharmacy and making a difference, we invite you to grow with us. Job Summary
The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and our customers. The Specialist is expected to be responsive and courteous when addressing customer needs and to uphold our standards of customer focus, trust, and professional conduct. Duties / Responsibilities
Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. Research, analyze, and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines. Ensure approval of claims by performing appropriate edits and/or reversals to maximize payer reimbursement. Contact providers and/or facility contacts as necessary to obtain additional information. Monitor and resolve revenue at risk associated with payer setup, billing, rebilling, and reversal processes. Work as a team to identify, document, communicate, and resolve payer/billing trends and issues. Complete, communicate, and submit prior authorization forms in a timely manner. Support training needs. Prepare and maintain reports and records for processing. Perform other tasks as assigned. Follow all applicable government regulations, including HIPAA. Comply with departmental policies regarding safety, attendance, and dress code. Overtime, holidays, and weekends may be required and/or expected. Conduct job responsibilities in accordance with the Company Code of Business Conduct and Ethics, policies and procedures, the Corporate Compliance Agreement, applicable laws, and professional standards. Other duties as assigned; job duties may vary depending on business needs. Qualifications / Competencies
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required Skills / Abilities
Able to read, write, speak, and understand the English language. Able to retain a large amount of information and apply that knowledge to related situations. Able to work in a fast-paced environment. Basic computer knowledge skills required. Basic math and analytical skills. Experience with alpha-numeric data entry. Proficient in Microsoft Word, Excel, and Outlook. Customer service oriented; results-focused; good organization and attention to detail. Reliable; problem solver; able to work various shifts and days. Adaptability to an ever-changing environment. Education and/or Experience
High School diploma or equivalent required. Minimum of one (1) year working as a pharmacy technician in a retail environment; long-term care pharmacy experience preferred. Framework LTC & General computer knowledge & 10-key number entry preferred. Physical Demands
The Physical Demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job. May sit or stand seven to ten hours per day. May be required to sit; climb or balance; stoop, kneel, or bend; walk. May work extended hours as needed. May lift and/or move up to 30 pounds. Work environment characteristics are representative of those encountered in performing the essential functions of this role. Holiday & PTO Policy
Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days. Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses. Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility. Please note, because we are a pharmacy, most locations are open 24 hours a day, 7 days a week; schedules may change based on business needs. Benefits for Full-Time Employees
Medical, dental, and vision insurance. 401(k) (available for part-time & full-time employees). Company-paid life insurance. Short-term and long-term disability insurance. Tuition reimbursement. Personal Time Off (PTO). Competitive pay with annual performance reviews and merit-based raises. Career growth potential. Annual on-site voluntary Flu Vaccines. Employee referral bonus program. Note: Seniority level, employment type, job function, and industries sections have been streamlined to display in a consistent, readable format.
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At Polaris Pharmacy Services, we’re a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. We are industry leaders raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support. Polaris was founded in 2015 and is locally and independently owned, with a growing national footprint. We offer competitive pay, robust benefits, and opportunities for career advancement. If you’re passionate about shaping the future of pharmacy and making a difference, we invite you to grow with us. Job Summary
The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and our customers. The Specialist is expected to be responsive and courteous when addressing customer needs and to uphold our standards of customer focus, trust, and professional conduct. Duties / Responsibilities
Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. Research, analyze, and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines. Ensure approval of claims by performing appropriate edits and/or reversals to maximize payer reimbursement. Contact providers and/or facility contacts as necessary to obtain additional information. Monitor and resolve revenue at risk associated with payer setup, billing, rebilling, and reversal processes. Work as a team to identify, document, communicate, and resolve payer/billing trends and issues. Complete, communicate, and submit prior authorization forms in a timely manner. Support training needs. Prepare and maintain reports and records for processing. Perform other tasks as assigned. Follow all applicable government regulations, including HIPAA. Comply with departmental policies regarding safety, attendance, and dress code. Overtime, holidays, and weekends may be required and/or expected. Conduct job responsibilities in accordance with the Company Code of Business Conduct and Ethics, policies and procedures, the Corporate Compliance Agreement, applicable laws, and professional standards. Other duties as assigned; job duties may vary depending on business needs. Qualifications / Competencies
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required Skills / Abilities
Able to read, write, speak, and understand the English language. Able to retain a large amount of information and apply that knowledge to related situations. Able to work in a fast-paced environment. Basic computer knowledge skills required. Basic math and analytical skills. Experience with alpha-numeric data entry. Proficient in Microsoft Word, Excel, and Outlook. Customer service oriented; results-focused; good organization and attention to detail. Reliable; problem solver; able to work various shifts and days. Adaptability to an ever-changing environment. Education and/or Experience
High School diploma or equivalent required. Minimum of one (1) year working as a pharmacy technician in a retail environment; long-term care pharmacy experience preferred. Framework LTC & General computer knowledge & 10-key number entry preferred. Physical Demands
The Physical Demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job. May sit or stand seven to ten hours per day. May be required to sit; climb or balance; stoop, kneel, or bend; walk. May work extended hours as needed. May lift and/or move up to 30 pounds. Work environment characteristics are representative of those encountered in performing the essential functions of this role. Holiday & PTO Policy
Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days. Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses. Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility. Please note, because we are a pharmacy, most locations are open 24 hours a day, 7 days a week; schedules may change based on business needs. Benefits for Full-Time Employees
Medical, dental, and vision insurance. 401(k) (available for part-time & full-time employees). Company-paid life insurance. Short-term and long-term disability insurance. Tuition reimbursement. Personal Time Off (PTO). Competitive pay with annual performance reviews and merit-based raises. Career growth potential. Annual on-site voluntary Flu Vaccines. Employee referral bonus program. Note: Seniority level, employment type, job function, and industries sections have been streamlined to display in a consistent, readable format.
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