Prior Authorization Specialist - Pharmacy Technician

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Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third‑party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.

The compensation range for this role is $19.00‑$23.00/hour, determined based on skills, experience, and qualifications. This a hybrid position based out of our Elk Grove Village, Illinois location that requires 2‑3 days in office. Travel to other locations may occur, although minimal.

This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions, and eligibility. Responsibilities include reading prescriptions, converting prescriptions into authorizations, and interpreting medical policies. Prior Authorization Representatives are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation, and initiate prior authorizations through insurance plans.

• Contact plans (PBM or Major Medical) to validate request sent from BV
• Contact physician’s office to obtain current prescriptions
• Contact physician’s office to obtain clinical documentation required by the plans
• Validate that the clinical documentation received is what is required by the plan
• Initiate prior authorizations through Cover My Meds
• Follow up on all pending PA’s within 48 hours
• Respond to urgent emails submitted by the Patient Care Coordinator Team or Program Manager in a timely manner
• Obtain approval/denial letters
• Submit all new Complex authorization approvals and/or Complex re‑authorization approvals through the Complex audit process
• Initiate re‑authorizations that are set to expire 30 days prior to the term date

• Experience with Major Medical Insurance
• Knowledge of Pharmacy Benefit
• Knowledge of HCPC Codes (J‑Codes)
• Knowledge of ICD‑10 Codes (Diagnoses Codes)
• Familiar with medical documentation such as H&P’s, Genetic testing, etc
• Ability to read prescriptions
• Ability to convert a prescription into an authorization request based on payer requirements
• Ability to interpret medical policies

• Medical Coverage, Dental, and Vision Coverage
• 401(k) with employer match
• Accident and Critical Illness coverage
• Company‑paid life insurance options
• Generous PTO, paid holidays, and floating holidays
• Tuition reimbursement program

Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case‑by‑case basis in accordance with applicable law.

Mid‑Senior level

Full‑time

Other

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