Pharmacy Prior Authorization Representative - Remote CT

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Pharmacy Prior Authorization Call Center (PPAAC) Representative supports the Connecticut Medicaid account in a fast-paced, high-volume call center environment. This role is responsible for answering and resolving inquiries from prescribers and pharmacies related to pharmacy claims and prior authorization requests, ensuring timely, accurate, and compliant processing.

Working as part of a small, specialized team, the PPAAC Representative is required to process all pharmacy prior authorizations within 24 hours of receipt. This position requires flexibility to work rotating shifts, including second and third shifts, as well as on-call coverage on a rotational basis. Other duties may be assigned as needed.

Your role in our mission

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

What We're Looking For

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

What You Should Expect In This Role

Remote work opportunity, but must reside in Connecticut.

Potential for in-office work in East Hartford as needed.

24/7/365 call center environment with rotating shifts:

Monday – Friday: 7:30 AM – 7:30 PM

Saturday (rotating schedule): 9:00 AM – 4:00 PM

All off-hours are covered on an on-call rotation.

A dynamic and fast-paced call center environment where accuracy and efficiency are key.

Work from Home: Reliable high-speed internet connectivity is essential. Minimum requirements are 24 Mbps download and 8 Mbps upload, with higher speeds recommended for optimal performance.

Interview Requirement: Video cameras must be used during all interviews.

The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.