Prior Authorization Specialist

Join PanCare as a Prior Authorization Specialist – Make a Meaningful Impact by Ensuring Patients Receive Essential Medications on Time

Are you passionate about healthcare and want to make a real difference in people’s lives? PanCare is looking for a dedicated and detail-oriented Prior Authorization Specialist to become an essential part of our team. In this role, you will be at the heart of the process, ensuring that patients get the medications they need without delay. By managing and coordinating prior authorizations for prescriptions, you’ll play a crucial part in breaking down barriers to care and helping our patients access the treatments they deserve.

If you’re an expert communicator with a deep understanding of insurance processes and pharmaceutical practices, and you're ready to make a lasting impact, this is the opportunity for you! Join PanCare and be part of a mission-driven team focused on providing the highest quality care to all our patients.

KEY RESPONSIBLITIES: 

• Submit and follow up on prior authorization requests for medications as required by insurance companies.
• Ensure the necessary documentation and clinical information is provided to support authorization requests.
• Review prescriptions and medical records to determine which medications require prior authorization.
• Communicate with healthcare providers to gather necessary information and ensure timely completion of the prior authorization process.
• Verify patient insurance coverage and identify medications that are subject to prior authorization requirements.
• Work closely with insurance providers to confirm the status of prior authorization requests, appeals, and reauthorizations.
• Notify patients and healthcare providers of the status of prior authorization requests and provide guidance on next steps if necessary.
• Address any concerns or questions related to prior authorization status and medication access.
• Assist patients in navigating their insurance benefits and help them understand the prior authorization process.
• Initiate and track appeals for denied prior authorization requests and work to resolve issues promptly.
• Monitor reauthorization timelines and ensure that medications continue to be covered without interruption.
• Maintain accurate records of prior authorization requests, approvals, denials, appeals, and follow-ups.
• Stay updated on insurance policies, formularies, and medication coverage changes to ensure compliance with industry standards and regulations.
• Work closely with pharmacists, pharmacy technicians, and healthcare providers to ensure a seamless process for patients requiring prior authorizations.
• Collaborate with internal teams to address any medication-related issues and provide feedback for process improvements.

QUALIFICATIONS:

Education: High school diploma or equivalent (required); Associate’s degree in health-related field preferred.

Experience: Minimum of 1-2 years of prior authorization experience, preferably in a pharmacy setting. Knowledge of insurance plans, pharmacy benefits, and prior authorization processes. Familiarity with pharmacy management systems and tools used for prior authorization requests is a plus.

SKILLS AND ABILITIES:

•  Strong attention to detail and accuracy in data entry and documentation.
• Excellent communication skills, both written and verbal, with the ability to interact with patients, healthcare providers, and insurance companies professionally.
• Ability to multitask and prioritize work in a fast-paced environment.
• Problem-solving skills, especially in addressing denied authorizations and appeals.
• Knowledge of HIPAA guidelines and confidentiality protocols.

PHYSICAL/MENTAL DEMANDS:  While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; talk or hear; stoop, bend, kneel, and crouch may be required in clinical areas. The employee frequently is required to sit and stoop, kneel, or crouch.  The employee must occasionally lift and/or move up to 30 pounds which includes the lifting, pushing and/or pulling of supplies and equipment. Ability to work in a stressful, public contact environment; maintenance of confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA).

PanCare of Florida is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by law. We believe that diversity and inclusion are key to our success, and we welcome applications from individuals of all backgrounds and experiences.