Pharmacy Prior Authorization Specialist

HAHHH; Worcester, Northern (MA, KY); Hybrid; USD 44,000 - 61,000; Full time

Job summary

UMass Memorial Health in Worcester, MA is seeking a Prior Authorization Coordinator to review general and oncology infusion requests, determine medical necessity, and secure correct benefits coverage.

You will collaborate with Insurance Verification, the Central Billing Office and other departments to resolve authorization issues, manage renewals, and maintain a shared database of authorization numbers while supporting process improvements in the Pharmacy Business Office.

Qualifications

• High School diploma required.
• 2-3 years of medical secretarial/administrative support experience.
• Proficiency with Microsoft Office and internet tools.
• Strong customer service skills and teamwork ability.

Responsibilities

• Reviews all prior authorizations for general and oncology infusions.
• Communicates with insurance carriers and internal departments to resolve authorization issues.
• Manages the incoming patient report and renewal tracking to prevent lapses.
• Maintains confidential files and supports performance improvement initiatives.

Skills

Microsoft Office

Customer service

Teamwork

Internet skills

Education

High School diploma

Tools

All Scripts

IDX

Job description

UMass Memorial Health in Worcester, MA is seeking a Prior Authorization Coordinator to review general and oncology infusion requests, determine medical necessity, and secure correct benefits coverage.

You will collaborate with Insurance Verification, the Central Billing Office and other departments to resolve authorization issues, manage renewals, and maintain a shared database of authorization numbers while supporting process improvements in the Pharmacy Business Office.