What are the responsibilities and job description for the Prior Authorization Support Specialist position at MedOne Pharmacy Benefit Solutions?
Position Overview:
The Prior Authorization Support Specialist is responsible for facilitating and supporting the prior authorization (PA) process to ensure timely access to medications and medical services. This role serves as a liaison between healthcare providers, payers, and internal utilization management teams to coordinate submissions, track requests, and ensure compliance with payer requirements.
About MedOne:
MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.
What You Will Do at MedOne:
Support operations of MedOne Clinical Service
Provide direct assistance to members seeking support throughout the prior authorization process
Assist in the submission, tracking, and follow-up of prior authorization requests for medications and/or medical services
Review documentation for completeness and accuracy prior to submission to health plans or pharmacy benefit managers (PBMs)
Communicate with prescribers, provider offices, pharmacies, and payers to obtain required clinical information
Monitor authorization status and ensure timely resolution of pending or denied requests
Support appeals and reconsideration processes by gathering necessary clinical documentation
Complete Proactive Prescriber Outreach Program (PPOP) calls to prescribers utilizing PPOP resources provided by the Clinical Operations team
Maintain accurate and up-to-date records in electronic systems
Identify and escalate urgent or complex cases as appropriate
Ensure compliance with regulatory requirements, payer policies, and internal procedures
Provide updates and status reports to internal stakeholders as needed
Assist with audits and quality assurance activities related to prior authorization workflows
Works to promote a team environment
Support the operation and maintenance of existing MedOne Clinical Services
Assists and supports members of MedOne Pharmacy Benefit Solutions
Portrays the company in a positive image
Required to abide by all rules, regulations and policies of the employer
Other duties as assigned
What you will bring to MedOne:
CPhT certification, or state equivalent at date of hire
High school diploma or equivalent (Associate’s or Bachelor’s degree preferred)
1–3 years of experience in healthcare, pharmacy, insurance, or prior authorization support
Basic understanding of pharmacy or medical terminology
Familiarity with prior authorization processes, claims, or payer requirements
Strong attention to detail and organizational skills
Excellent communication (verbal and written) and customer service skills
Ability to manage multiple tasks and meet deadlines in a fast-paced environment
Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees)
Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint
Familiarity with data entry software or CRM systems (Microsoft Dynamics) preferred
Must be able to type at a minimum of 30 words per minute
Must be able to work independently, meets deadlines, establish priorities, and be flexible
Must be able to stand/sit for long periods of time within limited space
Must be able to lift up to 25 pounds
Must be able to work cooperatively with MedOne staff
Why Join MedOne?
Competitive salary and bonuses that reward your performance
Comprehensive health, dental, and vision insurance
401(k) with company match to secure your future
Generous paid time off and holidays
Opportunities for professional growth and development
A vibrant and collaborative work culture