PAIN & SPINE - MEDICATION AUTHORIZATION SPECIALIST

Mountain View Hospital is looking for an Medication Authorization Specialist  to join our team!

JOB SUMMARY:  

The Medication Authorization Specialist is responsible for facilitating timely access to prescribed medications by coordinating insurance authorization processes, supporting clinical documentation, and collaborating with providers, clinical staff, and payers. This role ensures compliance with payer requirements, while minimizing delays in patient care.

BENEFITS: 

Taking care of our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

DUTIES AND RESPONSIBILITIES:

1. In a professional and friendly manner, answers incoming phone calls transferred to medication preauthorization department, answers preauthorization questions from patients, co-workers and providers.
2. Initiate, submit, and track medication prior authorization requests across multiple payer systems.
3. Review clinical documentation to ensure completeness and alignment with payer criteria.
4. Collaborate with providers and clinical staff to obtain necessary chart notes, labs, and supporting documentation.
5. Communicate with insurance companies, pharmacies, and patients regarding authorization status and requirements.
6. Follow up on pending authorizations and proactively resolve denials or delays.
7. Prepare and submit appeals, including drafting letters of medical necessity when appropriate.
8. Maintain accurate and timely documentation in the EMR.
9. Stay current on payer policies, formularies, and medication coverage updates.
10. Assist with identifying alternative medications when coverage barriers arise.
11. Is accountable for completing all assigned responsibilities/tasks and takes action when opportunities to improve are identified.
12. Maintains flexibility as department grows with willingness to accept additional responsibilities requested by department manager/supervisor/director.
13. Acts professional in every situation: patient, co-worker or inter-departmental.
14. Completes all annual mandatory education requirements (including hospital, department, and job specific competencies).
15. Ensure compliance with regulatory and organizational standards.
16. Promotes effective working relationships and works effectively as a part of the department/team to facilitate the hospital and department’s ability to meet its goals and objectives.

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

Education/Certification:  High School graduate or equivalent. Clinical certification (MA, CNA, CMA or Pharmacy Tech) preferred.

Experience:  Experience with medication prior-authorizations, insurance processes, or pharmacy workflows strongly preferred. Familiarity with EMR systems and payer portals.