PAIN & SPINE - MEDICATION AUTHORIZATION SPECIALIST

MOUNTAIN VIEW HOSPITAL LLC • Idaho Falls, ID

1d • Onsite

About The Position

Mountain View Hospital is looking for an Medication Authorization Specialist to join our team! The Medication Authorization Specialist is responsible for facilitating timely access to prescribed medications by coordinating insurance authorization processes, supporting clinical documentation, and collaborating with providers, clinical staff, and payers. This role ensures compliance with payer requirements, while minimizing delays in patient care.

Requirements

• High School graduate or equivalent.
• Experience with medication prior-authorizations, insurance processes, or pharmacy workflows strongly preferred.
• Familiarity with EMR systems and payer portals.

Nice To Haves

• Clinical certification (MA, CNA, CMA or Pharmacy Tech) preferred.

Responsibilities

• In a professional and friendly manner, answers incoming phone calls transferred to medication preauthorization department, answers preauthorization questions from patients, co-workers and providers.
• Initiate, submit, and track medication prior authorization requests across multiple payer systems.
• Review clinical documentation to ensure completeness and alignment with payer criteria.
• Collaborate with providers and clinical staff to obtain necessary chart notes, labs, and supporting documentation.
• Communicate with insurance companies, pharmacies, and patients regarding authorization status and requirements.
• Follow up on pending authorizations and proactively resolve denials or delays.
• Prepare and submit appeals, including drafting letters of medical necessity when appropriate.
• Maintain accurate and timely documentation in the EMR.
• Stay current on payer policies, formularies, and medication coverage updates.
• Assist with identifying alternative medications when coverage barriers arise.
• Is accountable for completing all assigned responsibilities/tasks and takes action when opportunities to improve are identified.
• Maintains flexibility as department grows with willingness to accept additional responsibilities requested by department manager/supervisor/director.
• Acts professional in every situation: patient, co-worker or inter-departmental.
• Completes all annual mandatory education requirements (including hospital, department, and job specific competencies).
• Ensure compliance with regulatory and organizational standards.
• Promotes effective working relationships and works effectively as a part of the department/team to facilitate the hospital and department’s ability to meet its goals and objectives.

Benefits

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED