Prior Authorization Coordinator

New

ProMod RxHealthcare pharmacy

United StatesFull-TimeMiddle

Salary21 - 23 USD per hour

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Job Details

Have a minimum of 3 years of pharmacy or healthcare experience.
Bring prior authorization experience or working knowledge of the prior authorization process; this is highly preferred.
Have a strong understanding of medical terminology and insurance plans and authorization.
Manage cases across multiple clientele programs and follow program business requirements.
Be proficient with data entry and Microsoft applications, with hands-on computer skills.
Be able to work independently and as part of a team.
Demonstrate communication, problem-solving, and customer service skills.
Have organizational and interpersonal skills, attention to detail, and the ability to multitask.
Be able to use multiple PC monitors and navigate several software systems.
Have a high school diploma or equivalent; a college degree is preferred.
State Pharmacy Technician registration or PTCB National Certification is preferred.

Manage the full lifecycle of prior authorization requests using payer portals, electronic submission platforms, fax, and telephonic outreach.
Coordinate between prescribers, specialty pharmacies, payers, and internal HUB teams from benefits investigation through authorization approval and therapy initiation.
Verify benefits and coverage to identify authorization requirements, payer restrictions, and access barriers.
Submit prior authorization requests with required clinical documentation and follow up with payers on determinations.
Work with provider offices to obtain clinical information and support appeals, reconsiderations, and medical exception requests.
Collaborate with reimbursement, copay assistance, patient assistance program, and specialty pharmacy partners to address treatment barriers.
Document case activities, payer interactions, and authorization statuses in the HUB CRM system.
Evaluate authorization outcomes and coordinate next steps, including appeals, bridge program eligibility, or alternative access solutions.
Monitor therapy status and coordinate authorization renewals to support continuity of care.
Maintain compliance with HIPAA, manufacturer program policies, and standard operating procedures.

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