Pharmacy Prior Authorization Specialist

Insurance Authorization Coordinator 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 Responsibilities Follow up with insurance companies through phone, fax, or online portals to obtain updates on prior authorization requests Enter authorization details, approval information, denial documentation, and related notes into internal systems accurately and timely Review denied authorization cases to confirm all required information is included prior to routing for additional review or appeal consideration Monitor assigned work queues and prioritize cases to minimize delays in treatment initiation or continuation Document payer interactions thoroughly, including call references, outcomes, and next steps Communicate authorization updates and issues with pharmacy, billing, and clinical support teams to maintain continuity of care Ensure authorization activities are completed in accordance with payer guidelines, company procedures, and regulatory requirements Identify recurring authorization trends, payer barriers, or process concerns and elevate findings when appropriate Qualifications Strong attention to detail and ability to accurately review insurance and authorization documentation Effective verbal and written communication skills when working with insurance representatives and internal departments Comfortable navigating multiple healthcare systems, payer portals, and electronic documentation platforms Ability to manage competing priorities and maintain productivity in a fast‑paced environment Education & Experience High school diploma or equivalent required At least 1-2 years of experience in healthcare administration, pharmacy support, insurance verification, or a related field preferred Prior experience with prior authorizations, pharmacy workflows, or medical terminology is highly preferred Benefits Verification Specialist The 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 Responsibilities Complete insurance benefit investigations and gather required documentation for authorization submissions Monitor pending authorizations and perform daily status follow‑up with insurance providers Assist with continuation authorizations and ongoing patient therapy support Enter and maintain accurate patient, insurance, and referral information within electronic systems Perform chart reviews and verify documentation completeness Communicate with insurance companies, provider offices, patients, and care teams regarding authorization or referral needs Coordinate with intake and operational teams to support workflow completion and patient care initiatives Maintain accurate records and ensure documentation complies with company standards and department expectations Utilize internal systems and reporting tools to support patient therapy management and compliance tracking Represent the organization professionally while collaborating with internal and external stakeholders Qualifications Strong organizational skills with the ability to multitask and adapt to changing priorities Excellent attention to detail and problem‑solving capabilities Professional communication and customer service skills Proficiency with Microsoft Office programs including Outlook, Excel, Teams, and Word Education & Experience High school diploma or GED required; additional college or technical education preferred Minimum of one year of experience in a pharmacy, healthcare, or insurance‑related setting Familiarity with Medicare, Medicaid, and third‑party insurance processes preferred #J-18808-Ljbffr Broughton Group