Prior Authorization Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the complete lifecycle of prior authorization requests for patient support programs sponsored by manufacturers.

• Utilize payer portals, electronic submission systems, fax, and phone outreach to ensure timely access to therapy.

• Facilitate coordination among prescribers, specialty pharmacies, payers, and internal HUB teams.

• Conduct benefits verification and coverage analysis to pinpoint authorization requirements, payer limitations, and access obstacles.

• Prepare thorough prior authorization requests with necessary clinical documentation and follow up with payers.

• Gather clinical information from provider offices and assist with first-level appeals, reconsiderations, and medical exception requests.

• Collaborate with reimbursement teams, copay assistance, patient assistance programs, and specialty pharmacy partners.

• Keep accurate case documentation, track payer interactions, and monitor authorization statuses in the HUB CRM system.

• Assess authorization outcomes and determine subsequent steps, including appeals, bridge program eligibility, or alternative access methods.

• Track therapy status and manage prior authorization renewals and reauthorizations.

• Ensure adherence to HIPAA regulations, manufacturer program guidelines, and standard operating procedures.

• Deliver professional and compassionate communication to patients and healthcare providers.

• Aid in the onboarding and continuous training of team members and contribute to the sharing of knowledge.

• Leverage knowledge of payer landscapes, specialty pharmacy processes, and manufacturer HUB services.

• Undertake additional responsibilities as needed to further patient access goals and the success of the HUB program.

⛳️ Requirements

• Previous experience managing prior authorizations or a solid understanding of the prior authorization process is highly preferred.

• Strong grasp of medical terminology, insurance plans, and authorization practices.

• Bilingual proficiency in English and Spanish is advantageous.

• A minimum of 3 years of experience in pharmacy or healthcare is required.

• Capacity to manage cases from various client programs and adhere to program business requirements.

• Competence in data entry, Microsoft applications, and general computer skills.

• Ability to work independently as well as collaboratively within a team setting.

• Excellent communication, problem-solving, and customer service abilities.

• Strong organizational and interpersonal skills, with a keen attention to detail and multitasking capability.

• Proficiency in using multiple PC monitors and navigating various software systems effectively.

• High School diploma is required.

• State Pharmacy Technician registration or PTCB National Certification is preferred.

• Must be able to sit, stand, and occasionally lift light objects.

🏝️ Benefits

• Full-time position with comprehensive benefits.

• A detailed list of benefits is available on the company website.