Medication Prior Authorization Coordinator

CONNECTICUT PULMONARY SPECIALISTS; New Haven (CT); On-site; USD 52,000 - 64,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Health insurance

Paid time off

Job summary

Connecticut Pulmonary Specialists, based in New Haven, CT, seeks a detail-oriented Medication Prior Authorization Coordinator to join our team. You will liaise with patients, providers, and insurers to secure timely access to medications and maintain accurate records in the EHR.

Responsibilities focus on initiating and following up on prior authorizations, gathering medical documentation, tracking statuses, and communicating outcomes to all parties.

Qualifications

• Experience in medication prior authorizations or healthcare administration.
• Familiarity with pulmonology or chronic disease management.
• Strong knowledge of payer guidelines, ICD/CPT coding.
• Proficiency with EHR systems; EPIC is a plus.

Responsibilities

• Initiate, manage, and follow up on prior authorization requests for prescribed medications with insurance carriers.
• Review clinical documentation and work closely with providers to gather necessary supporting information for authorization submissions.
• Track and monitor authorization statuses, ensuring timely approvals and minimal treatment delays.
• Communicate authorization outcomes to patients, pharmacies, and clinical staff in a clear and timely manner.
• Manage appeals and peer-to-peer review requests for denied authorizations.
• Maintain accurate and up-to-date records in the electronic health record (EHR) system.
• Stay current on payer policies, formulary changes, and prior authorization requirements.
• Order patient medication - for in office administered medications.

Skills

Prior authorization

Healthcare administration

Documentation & records

Communication skills

Education

High school diploma

Tools

EPIC

Job description

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off

About the Role: Connecticut Pulmonary Specialists is looking for a detail-oriented and driven Medication Prior Authorization Coordinator to join our team in New Haven, CT. In this vital role, you'll be the key link between our patients, providers, and insurance companies — ensuring timely access to critical medications. If you thrive in a fast-paced healthcare environment and are passionate about patient advocacy, we want to hear from you!

Responsibilities:

• Initiate, manage, and follow up on prior authorization requests for prescribed medications with insurance carriers
• Review clinical documentation and work closely with providers to gather necessary supporting information for authorization submissions
• Track and monitor authorization statuses, ensuring timely approvals and minimal treatment delays
• Communicate authorization outcomes to patients, pharmacies, and clinical staff in a clear and timely manner
• Manage appeals and peer-to-peer review requests for denied authorizations
• Maintain accurate and up-to-date records in the electronic health record (EHR) system
• Stay current on payer policies, formulary changes, and prior authorization requirements
• Order patient medication - for in office adminstered medications.

Requirements:

• Prior experience in medication prior authorizations, insurance verification, or healthcare administration preferred
• Familiarity with pulmonology, specialty medications, or chronic disease management is a plus
• Strong knowledge of insurance payer guidelines, medical terminology, and ICD/CPT coding
• Proficiency with electronic health record (EHR) systems, EPIC experience is a plus
• Excellent organizational skills with the ability to manage multiple cases and deadlines simultaneously
• Strong written and verbal communication skills for interacting with patients, providers, and payers
• High school diploma or equivalent required.

About Us:

Connecticut Pulmonary Specialists is a leading pulmonary and respiratory care practice serving the New Haven, CT community with a commitment to exceptional, patient-centered care. Our patients trust us for our expertise in treating complex respiratory conditions, and our team members value the collaborative, supportive environment we've built together. We are proud to be a practice where dedicated professionals can grow their careers while making a meaningful difference in patients' lives every day.