Medication Prior Authorization Specialist

EXPRESS PAIN AND URGENT CARE PLLC•San Antonio, TX

8d•Onsite

About The Position

Medication Prior Authorization Specialist – Epic Pain Management About Us Epic Pain Management is a patient-centered interventional pain management practice committed to providing high-quality, compassionate care and improving access to treatment for our patients. Our team works collaboratively across clinical, administrative, and operational departments to ensure patients receive timely, coordinated care throughout their treatment journey. Position Overview We are seeking a detail-oriented and highly organized Medication Prior Authorization Specialist to join our team at our Stone Oak location in San Antonio, Texas. The Medication Prior Authorization Specialist is responsible for managing medication prior authorizations across commercial insurance, Medicare, Medicaid, workers’ compensation, urgent care, and personal injury cases. This position plays an important role in ensuring authorization requests are submitted accurately, followed through to resolution, and appropriately documented to help prevent unnecessary delays in patients receiving prescribed medications. The ideal candidate is comfortable working with insurance requirements, pharmacies, clinical documentation, authorization portals, and high-volume patient communication while maintaining accuracy and professionalism.

Requirements

High school diploma or equivalent required.
Previous experience with medication prior authorizations, pharmacy benefits, medical insurance, healthcare administration, or a medical office strongly preferred.
Experience working with commercial insurance, Medicare, Medicaid, workers’ compensation, or personal injury cases preferred.
Knowledge of medication authorization and insurance denial/appeal processes preferred.
Experience communicating with pharmacies, insurance carriers, healthcare providers, and patients.
Strong computer skills and ability to navigate electronic health records, insurance portals, and authorization systems.
Excellent organizational skills with the ability to manage multiple pending cases and deadlines simultaneously.
Strong written and verbal communication skills.
High level of accuracy and attention to detail.
Ability to handle confidential patient and medical information appropriately.
Ability to work independently while collaborating effectively with clinical and administrative teams.

Nice To Haves

Bilingual English/Spanish skills are a plus.

Responsibilities

Review voicemail messages, authorization queues, patient cases, and determination notifications daily.
Submit and track medication prior authorization requests accurately and within required timeframes.
Identify reasons for rejected or denied authorization requests and follow established procedures for resolution.
Verify prescription information and review Prescription Monitoring Program (PMP) information when required for scheduled medications.
Educate patients regarding limited-day medication supplies, insurance requirements, and the prior authorization process.
Follow up with patients and pharmacies to confirm medication approval and resolve processing or dispensing issues.
Prepare and submit appeals, reconsiderations, and letters of medical necessity for denied medication requests.
Resubmit authorization requests when additional clinical documentation, prescription information, or proof of medication pickup is required.
Coordinate with providers and clinical staff when insurance carriers require alternative medications, additional documentation, or clarification.
Submit and track workers’ compensation medication authorizations according to payer-specific requirements and guidelines.
Prepare required forms, supporting documentation, and letters of medical necessity for workers’ compensation cases.
Process urgent care medication authorizations, including high-volume Medicaid and Medicare requests.
Assist with medication authorizations associated with personal injury cases, including obtaining necessary insurance information and processing requests appropriately.
Maintain complete, accurate, and organized documentation for active, pending, approved, and denied authorization requests.
Answer incoming calls and make outbound calls to patients, pharmacies, insurance carriers, and other appropriate parties regarding authorization status.
Screen and route calls appropriately and create patient cases when additional clinical or administrative follow-up is required.
Assist with medication refill requests when patients meet established clinical and eligibility requirements.
Provide language assistance to patients when applicable.
Maintain patient confidentiality and comply with HIPAA and organizational privacy requirements.
Provide support in other operational areas as needed to maintain efficient workflow across the organization.