Prior Authorization Specialist

Position Summary

The Prior Authorization Specialist is responsible for managing and completing prior authorization requests for medications, procedures, and services in a timely and accurate manner. This role requires strong attention to detail, excellent organizational skills, and the ability to communicate effectively with insurance companies, pharmacies, and providers. The ideal candidate must have direct experience using CoverMyMeds and working directly with insurance companies to secure approvals.

Key Responsibilities:

• Process and submit prior authorization requests for medications, procedures, and services through CoverMyMeds and other payerspecific portals.
• Communicate directly with insurance companies to verify coverage, resolve authorization issues, and obtain timely approvals.
• Review clinical documentation to ensure all necessary information is provided for authorization submission.
• Follow up on pending authorizations, document outcomes, and maintain accurate records within the EMR and tracking systems.
• Notify providers and patients of authorization approvals, denials, or requests for additional documentation.
• Assist in appeals by preparing required documentation and communicating with insurance carriers as needed.
• Maintain uptodate knowledge of insurance guidelines, formularies, step therapy requirements, and payer policies.
• Collaborate with prescribing clinicians to ensure all required clinical details are collected for authorization submissions.
• Identify recurring authorization barriers and suggest workflow improvements to increase approval efficiency.
• Protect patient confidentiality and comply with HIPAA regulations.
  
  

Required Qualifications:

• Minimum 12 years of direct experience processing prior authorizations.
• Handson experience with CoverMyMeds is REQUIRED.( If you do not have experience with CoverMyMeds please do not apply as you will not be considered)
• Must have previous experience communicating directly with insurance companies to obtain approvals or resolve denials.
• Knowledge of pharmacy benefits, medical benefits, and common insurance terminology.
• Strong attention to detail and accuracy.
  
  

Excellent written and verbal communication skills.

Ability to multitask, prioritize, and maintain productivity in a fast-paced environment.

Familiarity with EMRs/EHRs and basic computer skills.

Preferred Qualifications:

• Experience in a medical office, behavioral health practice, or specialty practice.
• Understanding appeals workflows.
• Knowledge of medical coding (ICD10, CPT) is a plus.
  
  

Work Environment:

• Parttime position (20 hours) fully remote
• Independent work environment with minimal patient or staff interaction required.
• Requires consistent communication with insurance companies and electronic submission portals.