Pharmacy Prior Authorization Specialist - 250193

The Insurance Authorization Coordinator supports the prior authorization process by managing insurance follow-up activities, maintaining accurate documentation, and partnering with internal teams to help prevent delays in patient care. This role is responsible for communicating with insurance carriers to obtain updates on submitted authorization requests, documenting approvals and denials within internal systems, and reviewing denial information before escalating cases for additional clinical review. The coordinator plays an important role in maintaining workflow efficiency, supporting compliance standards, and helping ensure timely therapy access for patients.Key ResponsibilitiesFollow up with insurance companies through phone, fax, or online portals to obtain updates on prior authorization requestsEnter authorization details, approval information, denial documentation, and related notes into internal systems accurately and timelyReview denied authorization cases to confirm all required information is included prior to routing for additional review or appeal considerationMonitor assigned work queues and prioritize cases to minimize delays in treatment initiation or continuationDocument payer interactions thoroughly, including call references, outcomes, and next stepsCommunicate authorization updates and issues with pharmacy, billing, and clinical support teams to maintain continuity of careEnsure authorization activities are completed in accordance with payer guidelines, company procedures, and regulatory requirementsIdentify recurring authorization trends, payer barriers, or process concerns and escalate findings when appropriateQualificationsStrong attention to detail and ability to accurately review insurance and authorization documentationEffective verbal and written communication skills when working with insurance representatives and internal departmentsComfortable navigating multiple healthcare systems, payer portals, and electronic documentation platformsAbility to manage competing priorities and maintain productivity in a fast-paced environmentEducation & ExperienceHigh school diploma or equivalent requiredAt least 1–2 years of experience in healthcare administration, pharmacy support, insurance verification, or a related field preferredPrior experience with prior authorizations, pharmacy workflows, or medical terminology is highly preferredThe Benefits Verification Specialist is responsible for supporting the prescription intake and reimbursement process by completing insurance benefit investigations and assisting with authorization requirements for new and existing patients. This role works closely with patients, providers, insurance carriers, and internal departments to help ensure timely processing of therapy orders while maintaining excellent customer service and documentation accuracy.Key ResponsibilitiesComplete insurance benefit investigations and gather required documentation for authorization submissionsMonitor pending authorizations and perform daily status follow-up with insurance providersAssist with continuation authorizations and ongoing patient therapy supportEnter and maintain accurate patient, insurance, and referral information within electronic systemsPerform chart reviews and verify documentation completenessCommunicate with insurance companies, provider offices, patients, and care teams regarding authorization or referral needsCoordinate with intake and operational teams to support workflow completion and patient care initiativesMaintain accurate records and ensure documentation complies with company standards and department expectationsUtilize internal systems and reporting tools to support patient therapy management and compliance trackingRepresent the organization professionally while collaborating with internal and external stakeholdersQualificationsStrong organizational skills with the ability to multitask and adapt to changing prioritiesExcellent attention to detail and problem-solving capabilitiesProfessional communication and customer service skillsProficiency with Microsoft Office programs including Outlook, Excel, Teams, and WordEducation & ExperienceHigh school diploma or GED required; additional college or technical education preferredMinimum of one year of experience in a pharmacy, healthcare, or insurance-related settingFamiliarity with Medicare, Medicaid, and third-party insurance processes preferred