Prior Authorization Coordinator

$21 - $23 per hour

ProCare Rx

Gainesville, GA

Status: Hourly, Non-Exempt

Hourly Rate: $21.00 - $23.00

JOB 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
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.

QUALIFICATIONS AND REQUIREMENTS
Previous Experience:

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.
Bilingual English/Spanish is a plus.
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.

Education:

High School Graduate required, College degree preferred.
State Pharmacy Technician registration or PTCB National Certification preferred.

Physical Demands:

Requires sitting, standing, and occasional light lifting.

This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our website for more information about our benefits list.

ProMod Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at View email address on click.appcast.io.

ProMod Rx is an Equal Opportunity Employer.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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Vacancy posted 4 days ago

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