Prior Authorization Coordinator

Job not on LinkedIn

🔥 6 hours ago

🇺🇸 United States – Remote

💵 $21 - $23 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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ProCare Rx

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

ProCare Rx is a pharmacy benefit manager (PBM) that delivers comprehensive pharmacy benefit management solutions focused on transparency, flexibility, and clinical excellence. The company provides claims adjudication, clinical services, rebate management, cost-containment programs, and specialized offerings such as GLP-1 and hospice medication management through a high-performance, web-enabled claims processing platform and U. S. -based support. ProCare Rx serves institutional and enterprise clients with claim-level analytics, 24/7 customer service, and scalable transaction processing.

📋 Description

• Manage the full lifecycle of prior authorization requests for manufacturer-sponsored patient support programs • Use payer portals, electronic submission platforms, fax, and telephonic outreach to facilitate timely therapy access • Coordinate between prescribers, specialty pharmacies, payers, and internal HUB teams • Conduct benefits verification and coverage analysis to identify authorization requirements, payer restrictions, and access barriers • Submit complete prior authorization requests with required clinical documentation and follow up with payers • Obtain clinical information from provider offices and support first-level appeals, reconsiderations, and medical exception requests • Collaborate with reimbursement, copay assistance, patient assistance programs, and specialty pharmacy partners • Maintain compliant case documentation, payer interactions, and authorization statuses in the HUB CRM system • Evaluate authorization outcomes and determine next steps, including appeals, bridge program eligibility, or alternative access solutions • Monitor therapy status and coordinate prior authorization renewals and reauthorizations • Ensure compliance with HIPAA, manufacturer program policies, and standard operating procedures • Provide professional and empathetic communication to patients and healthcare providers • Support onboarding and ongoing training of team members and contribute to knowledge sharing • Apply knowledge of payer landscapes, specialty pharmacy workflows, and manufacturer HUB services • Perform additional duties as needed to support patient access objectives and HUB program success

🎯 Requirements

• 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 ability to multitask • Ability to use multiple PC monitors and navigate through several software systems effectively • High School Graduate required • State Pharmacy Technician registration or PTCB National Certification preferred • Requires sitting, standing, and occasional light lifting

🏖️ Benefits

• Full-time position with benefits • Benefits list available on the company website

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