Prior Authorization Coordinator

Neurology Care•Ardmore, OK

About The Position

In a neurology practice, the Prior Authorization Coordinator obtains insurance authorizations for medications, specialty drugs, infusions, and related therapies. The role works closely with providers, clinical staff, pharmacies, patients, and insurance companies to obtain timely approval for prescribed treatments while maintaining compliance with payer requirements and organizational policies. The coordinator also manages authorization documentation, appeals, denials, reimbursement coordination, and medication sample inventory.

Requirements

Extensive experience in prior authorization, utilization management, or managed care.
Strong leadership, organizational, and analytical skills to manage multiple requests and optimize revenue cycle performance.
Strong customer service skills.
Excellent organizational and time management abilities.
Attention to detail and ability to multi-task.

Nice To Haves

Experience in neurology or specialty care is preferred.

Responsibilities

Submit and track medication prior authorization requests through insurance portals, fax, phone, and electronic medical record systems.
Coordinate Botox prior authorizations to support timely approvals and continuity of patient treatment plans.
Obtain and verify insurance benefits, eligibility, and pharmacy coverage information.
Collect and submit clinical documentation, laboratory results, progress notes, and supporting medical records.
Monitor authorization status and follow up with insurance companies to prevent delays in patient care.
Prepare and submit prior authorization appeals and reconsideration requests when coverage is denied.
Communicate authorization approvals, denials, and coverage updates to providers, pharmacies, infusion centers, and patients.
Assist patients with copay assistance programs, manufacturer patient assistance programs, and specialty pharmacy coordination when applicable.
Collaborate with physicians, clinical staff, pharmacies, and insurance companies to support continuity of care and timely treatment initiation.
Coordinate with providers regarding payer requirements, formulary alternatives, and appeal recommendations.
Manage medication sample inventory, tracking, documentation, and distribution in compliance with clinic and pharmaceutical guidelines.
Maintain accurate documentation of authorization activity within the electronic medical record.
Adhere to HIPAA and insurance compliance standards, payer regulations, and organizational policies.
Manage complex insurance authorizations, appeals, denials, peer-to-peer reviews, and reimbursement coordination across multiple payers.
Serve as a subject matter expert on healthcare regulations, payer requirements, and prior authorization policies.
Perform other duties as assigned.