Prime Therapeutics · 7 hours ago
Prior Authorization Analyst Sr
Minneapolis, MN
Full-time
Onsite
Mid, Senior Level
$81K/yr - $138K/yr
5+ years expPrime Therapeutics is a unique pharmacy benefit manager with a focus on connecting care for those they serve. The Senior Prior Authorization Analyst will provide advanced subject matter expertise for complex problem solving related to pharmacy claims processing and prior authorizations.
Health CarePharmaceutical
No H1B
Responsibilities
Functional subject matter expert for prior authorization input, maintenance and issue resolution in the pharmacy claim adjudication system
Collaborate with internal partners to create a clear understanding of request intent, desired prior authorization outcome, and implementation process expectations, including timeframe and data requirements
Ensure quality maintenance and implementation of prior authorization loads, whether processed individually or in bulk, by completing thorough analysis of the implementation requirements, validating planned approach, completing accurate entry of prior authorizations and executing peer review or other quality assessments
Responsible for the resolution of more complex assignments received by the team
Responsible for the development, testing and deployment of macros to support the work of the Prior Authorization processes
Identify new efficiencies and enhance current processes as needed
May assist with mentoring and training Analyst level colleagues
Other duties as assigned
Qualification
Required
Bachelor's degree in Business Administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required
5 years of benefits, claims, or PBM operations experience
Must be eligible to work in the United States without need for a work visa or residency sponsorship
Preferred
Previous experience with Medicare or Medicaid
Previous project management experience
Knowledge of drugs and drug categorization
Intermediate level Microsoft database and skills
Excellent verbal and written communication skills
Capable of handling multiple projects, managing work priority, setting and meeting deadlines
Ability to work in a collaborative, team-based environment
Strong analytical and problem-solving skills with attention to detail
Ability to analyze and solve complex problems using analytical tools (e.g. Microsoft Excel, Microsoft Access, SAS/query tools)
High Proficiency in RxClaims analysis, including benefits, pricing, eligibility, network and plan set-up
Experience working on cross-functional projects
Experience performing data analysis and validation
Strong desire to be a subject matter expert
High Proficiency in RxClaim, Lotus Notes (CRT), Microsoft Office Products (Word, Excel, Outlook), Clinical Review Engine (CRE)
Company
Prime Therapeutics
Prime Therapeutics is a trusted pharmacy solutions partner delivering savings, simplicity & support to our customers and members
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Mostafa Kamal
President & Chief Executive Officer
Kenneth Bodmer
Chief Financial Officer
Recent News
2025-10-31
Company data provided by crunchbase