Medication Authorization Specialist, Bend OR

Praxis Health•Bend, OR

25d•Onsite

About The Position

High Lakes Health Care , part of Praxis Health, is seeking a detail-oriented and knowledgeable Medication Authorization Specialist to support our healthcare team by managing the prior authorization process for prescribed medications. This role ensures that patients receive timely access to medications by coordinating with healthcare providers, insurance companies, and pharmacies while verifying coverage requirements and formularies. The ideal candidate has strong experience in medication prior authorizations, insurance policies, and healthcare documentation. Schedule: Monday - Friday, 8:00am - 5:00pm We are excited to share with you a short video that shows why the Praxis Health family is so special. Please click here: https://youtu.be/MrNWtn42prY About Our Company Praxis Health is a family of medical groups providing high-quality healthcare throughout the state of Oregon. Our community-based clinics are the DNA of our business, providing better medicine, advocacy for our patients, and a satisfying and collaborative culture for our providers and staff. The Praxis family approach is dynamically different from other healthcare companies in Oregon. We are not “big box” health care, but rather a company of small groups and clinics, of nimble micro-cultures that can quickly adapt to industry changes, as well as patient needs. We have been serving communities across the beautiful and adventurous state of Oregon for over 50 years! And we are pioneers and thought leaders in the industry. Our commitment to innovative and operational excellence has allowed us to create healthcare solutions that are both cost-efficient and cutting edge. Come see how healthcare is done right! General Physical Requirements Manual dexterity for office machine operation including computer and calculator; stooping, bending to handle files and supplies, mobility to complete errands for deliveries, or sitting for extended periods of time. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Stress can be triggered by multiple staff demands and deadlines. Work is performed in an office environment. Involves frequent contact with staff and patients.

Requirements

High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, pharmacy technology, or related field preferred.
2+ years of experience in healthcare , preferably in medication prior authorizations or pharmacy services.
Strong knowledge of insurance plans, prior authorization workflows, formularies, and medication coverage requirements .
Experience working with EHR systems and payer authorization portals .
Familiarity with medical terminology, specialty medications, and clinical documentation.
Knowledge of medication prior authorization processes
Insurance verification and payer policy interpretation
Formulary and medication coverage management
Attention to detail and documentation accuracy
Strong communication and problem-solving skills
Ability to manage multiple cases and deadlines

Nice To Haves

Certified Pharmacy Technician (CPhT) or similar certification is a plus.

Responsibilities

Manage and process medication prior authorizations for prescribed treatments.
Review patient insurance plans to determine coverage requirements, formulary restrictions, and authorization guidelines .
Submit prior authorization requests through payer portals, electronic systems, or phone/fax as required.
Gather and review clinical documentation needed to support authorization requests.
Communicate with physicians, clinical staff, pharmacies, and insurance representatives to resolve authorization issues.
Track authorization status and follow up with payers to ensure timely approvals or denials.
Identify alternative medications when required due to formulary restrictions and coordinate with providers.
Maintain accurate documentation of authorization activities in the electronic health record (EHR) or practice management system.
Monitor and stay current on payer policies, medication guidelines, and regulatory changes.
Reliable attendance and presence at work.