Prior Authorization Coordinator

MC-Rx Powered by ProCare Rx•Gainesville, GA

14d•Onsite

About The Position

The Prior Authorization Coordinator will manage the full lifecycle of prior authorization (PA) requests to support manufacturer-sponsored patient support programs. This role involves utilizing various communication channels and systems to facilitate timely access to therapy. The coordinator will act as a central point of contact between prescribers, specialty pharmacies, payers, and internal HUB teams, ensuring a seamless process from benefits investigation to therapy initiation. A key aspect of the role is conducting comprehensive benefits verification and coverage analysis to identify PA requirements and potential access barriers. The coordinator will submit accurate PA requests with necessary clinical documentation and follow up with payers to expedite determinations. They will also partner with provider offices to obtain clinical information, support appeals, and collaborate with internal teams to remove financial and administrative barriers. Maintaining detailed and compliant documentation in the HUB CRM system is crucial for transparency and audit readiness. The role involves evaluating authorization outcomes, coordinating renewals, and ensuring adherence to regulatory and privacy requirements like HIPAA. A high-touch customer experience with patients and healthcare providers is expected. Additionally, the coordinator will support team onboarding and training, contribute to knowledge sharing, and demonstrate a strong understanding of payer landscapes and program requirements. This is a full-time position with benefits.

Requirements

Previous experience in managing prior authorizations or working knowledge of the prior authorization process is highly preferred.
Strong understanding of medical terminology, insurance plans and authorization.
Minimum 3 years of pharmacy or healthcare experience.
Ability to manage cases from multiple clientele programs and follow program business.
Proficiency with data entry functions, Microsoft applications, and hands-on computer skill.
Ability to work independently and on a team.
Excellent communication, problem solving and customer service.
Strong organizational /interpersonal skills; attention to detail and the ability to multitask.
Ability to use multiple PC monitors and navigate through several software systems effectively.
High School Graduate required.
State Pharmacy Technician registration or PTCB National Certification preferred.

Nice To Haves

Bilingual English/Spanish is a plus.
College degree preferred.
State Pharmacy Technician registration or PTCB National Certification preferred.

Responsibilities

Manage the full lifecycle of prior authorization (PA) requests in support of manufacturer-sponsored patient support programs, utilizing payer portals, electronic submission platforms, fax, and telephonic outreach to facilitate timely access to therapy.
Serve as a central coordination point between prescribers, specialty pharmacies, payers, and internal HUB teams to ensure seamless progression from benefits investigation through authorization approval and therapy initiation.
Conduct comprehensive benefits verification and coverage analysis to identify prior authorization requirements, payer restrictions, and potential access barriers; initiate and track PA submissions accordingly.
Submit accurate and complete prior authorization requests, including all required clinical documentation, and perform proactive follow-up with payers to expedite determinations and minimize delays in therapy access.
Partner closely with provider offices to obtain clinical information, clarify prescribing intent, and support the development and submission of first-level appeals, reconsiderations, and medical exception requests.
Collaborate cross-functionally with HUB teams including reimbursement, copay assistance, patient assistance programs (PAP), and specialty pharmacy partners to remove financial and administrative barriers to treatment.
Maintain detailed, compliant documentation of all case activities, payer interactions, and authorization statuses within the HUB CRM system to ensure transparency, reporting accuracy, and audit readiness.
Evaluate authorization outcomes to determine next steps, including appeals, bridge program eligibility, or alternative access solutions in alignment with manufacturer program.
Monitor therapy status and coordinate prior authorization renewals or reauthorizations to support continuity of care and prevent treatment interruptions.
Ensure adherence to all regulatory and privacy requirements, including the Health Insurance Portability and Accountability Act (HIPAA), as well as manufacturer program policies and standard operating procedures.
Deliver a high-touch customer experience by maintaining professional, empathetic communication with patients and healthcare providers throughout the access process.
Support onboarding and ongoing training of team members; contribute to knowledge sharing and best practices within the HUB environment.
Demonstrate strong knowledge of payer landscapes, specialty pharmacy workflows, and manufacturer HUB services, ensuring alignment with program-specific requirements.
Perform additional duties as needed to support patient access objectives and overall HUB program success.