Gainwell Technologies · 16 hours ago
Pharmacy Prior Authorization Representative - Remote CT
United States
Full-time
Remote
Mid Level
$34K/yr - $48K/yr
3+ years expGainwell Technologies is a leader in healthcare solutions, seeking a Pharmacy Prior Authorization Call Center Representative to support the Connecticut Medicaid account. This role involves processing pharmacy prior authorizations, answering inquiries from prescribers and pharmacies, and ensuring compliance with relevant guidelines.
Health CareInformation Technology
Responsibilities
Serve as a primary point of contact for prescribers and pharmacies regarding pharmacy claims and prior authorization inquiries
Analyze pharmacy claims and provide accurate clarification, verification, and resolution to provider inquiries
Process prior authorization requests, including approvals and denials, and document rationale in accordance with policy
Accurately document all call interactions, inquiries, decisions, and resolutions in the system
Maintain confidentiality and compliance with HIPAA and Connecticut Medicaid guidelines
Qualification
Required
Knowledge of pharmacy claims processing and pharmacy dispensing systems, with exposure to Medicaid and/or Medicare Part D programs
Ability to work effectively in a high-paced, high-volume environment with strong multi-tasking and time management skills
Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience working in a paperless, technology-driven environment
Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams
Active Connecticut Pharmacy Technician license, along with prior retail pharmacy or customer service experience
Benefits
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
Company data provided by crunchbase