Prior Authorization Analyst Sr (Remote)

Job Description

Company: Prime Therapeutics

Job Type: Full-Time

Work Mode: 100% Remote

Salary Range: $81,000 – $138,000 per year (based on experience & skills)

Location Eligibility: United States Only

About Prime Therapeutics

At Prime Therapeutics, we’re a purpose-driven Pharmacy Benefit Manager (PBM) focused on improving health outcomes—not profits alone. We uniquely connect pharmacy, medical, and clinical care to better serve members and communities. If you’re looking for meaningful work in healthcare operations, Prime offers a collaborative and mission-focused environment where your expertise truly matters.

Job Overview

The Senior Prior Authorization Analyst provides advanced subject matter expertise in pharmacy claims processing, with a focus on prior authorizations tied to clinical programs and operational decision-making. This role supports complex analysis, system configuration, process optimization, and cross-functional collaboration within PBM operations.

Key Responsibilities

• Serve as a functional subject matter expert for prior authorization configuration, maintenance, and issue resolution in pharmacy claim adjudication systems
• Collaborate with internal stakeholders to define request intent, expected outcomes, timelines, and data requirements
• Ensure accurate and high-quality implementation of prior authorization loads (individual and bulk)
• Perform detailed analysis, validation, and peer review to ensure implementation accuracy
• Resolve complex and escalated assignments within the Prior Authorization team
• Develop, test, and deploy macros to improve prior authorization workflows
• Identify opportunities to enhance efficiency and streamline operational processes
• Assist with mentoring and training Analyst-level team members
• Perform additional duties as assigned

Minimum Qualifications

• Bachelor’s degree in Business Administration or a related field
  (or equivalent combination of education and relevant experience)
• High School Diploma or GED required
• 5+ years of experience in benefits administration, claims processing, or PBM operations
• Must be eligible to work in the United States without visa or sponsorship

Additional Qualifications

• Experience working with Medicare and/or Medicaid programs
• Prior project management experience
• Knowledge of pharmaceuticals and drug classification
• Intermediate-level Microsoft database and analytical skills
• Strong verbal and written communication abilities
• Ability to manage multiple priorities and meet deadlines
• Strong analytical, critical thinking, and problem-solving skills
• Proficiency in analytical tools such as Excel, Access, SAS, or query tools
• High proficiency in RxClaims analysis, including benefits, pricing, eligibility, networks, and plan setup

Preferred Qualifications

• Experience on cross-functional or enterprise-level projects
• Background in data analysis and validation
• Desire to grow as a subject matter expert
• Advanced proficiency with:
  • RxClaim
  • Lotus Notes (CRT)
  • Microsoft Office (Word, Excel, Outlook)
  • Clinical Review Engine (CRE)

Compliance & Accessibility

• Employees must comply with all applicable security, legal, regulatory, and contractual requirements
• Reasonable accommodations will be provided for qualified individuals with disabilities
• Prime reserves the right to modify job duties as needed

Equal Opportunity Employer

Prime Therapeutics LLC is an Equal Opportunity and Affirmative Action Employer. We encourage applications from individuals of all backgrounds and do not discriminate based on race, religion, gender, age, disability, veteran status, arrest or conviction history, or any other legally protected status.