Prior Authorization Coordinator

MC-Rx; Gainesville (GA); On-site; USD 28,929 - 31,684; Full time

Job summary

ProMod Rx in Gainesville, GA is seeking an hourly, non-exempt Prior Authorization Specialist to manage PA requests across payer portals and communication channels to expedite patient access to therapy.

You will verify benefits, coordinate with prescribers, HUB teams, and specialty pharmacies; ensure accurate documentation while adhering to HIPAA and program policies. A minimum of 3 years in pharmacy/healthcare is expected, with HS diploma; bilingual English/Spanish a plus.

Qualifications

• Minimum 3 years of pharmacy or healthcare experience.
• Previous experience managing prior authorizations.
• Bilingual English/Spanish is a plus.

Responsibilities

• Manage complete PA lifecycle across payer portals and submission platforms.
• Coordinate with prescribers, HUB teams, and pharmacies to advance authorization.
• Verify benefits and identify PA requirements to minimize delays.
• Submit PA requests with required clinical documents and follow up proactively.
• Collaborate with providers to support first-level appeals and medical exceptions.
• Maintain compliant case documentation and audit readiness.
• Monitor renewals and reauthorizations to ensure continuity of therapy.
• Ensure HIPAA compliance and privacy when handling patient data.

Skills

Prior authorization

Medical terminology

Customer service

Bilingual English/Spanish

Data entry

Microsoft Office

Multitasking

Education

High School Graduate

PTCB/CPhT preferred

Tools

MS Office

Job description

Status: Hourly, Non-Exempt

Hourly Rate: $21.00 - $23.00

Location: Onsite, Gainesville, GA

Job Responsibilities

• Manage the full lifecycle of prior authorization (PA) requests in support of manufacturer-sponsored patient support programs, utilizing payer portals, electronic submission platforms, fax, and telephonic outreach to facilitate timely access to therapy.
• Serve as a central coordination point between prescribers, specialty pharmacies, payers, and internal HUB teams to ensure seamless progression from benefits investigation through authorization approval and therapy initiation.
• Conduct comprehensive benefits verification and coverage analysis to identify prior authorization requirements, payer restrictions, and potential access barriers; initiate and track PA submissions accordingly.
• Submit accurate and complete prior authorization requests, including all required clinical documentation, and perform proactive follow-up with payers to expedite determinations and minimize delays in therapy access.
• Partner closely with provider offices to obtain clinical information, clarify prescribing intent, and support the development and submission of first-level appeals, reconsiderations, and medical exception requests.
• Collaborate cross-functionally with HUB teams including reimbursement, copay assistance, patient assistance programs (PAP), and specialty pharmacy partners to remove financial and administrative barriers to treatment.
• Maintain detailed, compliant documentation of all case activities, payer interactions, and authorization statuses within the HUB CRM system to ensure transparency, reporting accuracy, and audit readiness.
• Evaluate authorization outcomes to determine next steps, including appeals, bridge program eligibility, or alternative access solutions in alignment with manufacturer program.
• Monitor therapy status and coordinate prior authorization renewals or reauthorizations to support continuity of care and prevent treatment interruptions.
• Ensure adherence to all regulatory and privacy requirements, including the Health Insurance Portability and Accountability Act (HIPAA), as well as manufacturer program policies and standard operating procedures.
• Deliver a high-touch customer experience by maintaining professional, empathetic communication with patients and healthcare providers throughout the access.
• Support onboarding and ongoing training of team members; contribute to knowledge sharing and best practices within the HUB environment.
• Demonstrate strong knowledge of payer landscapes, specialty pharmacy workflows, and manufacturer HUB services, ensuring alignment with program-specific requirements.
• Perform additional duties as needed to support patient access objectives and overall HUB program success.

Qualifications and Requirements

Previous Experience

• 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 the ability to multitask.
• Ability to use multiple PC monitors and navigate through several software systems effectively.

Education

• High School Graduate required, College degree preferred.
• State Pharmacy Technician registration or PTCB National Certification preferred.

Physical Demands

• Requires sitting, standing, and occasional light lifting.

ProMod Rx is an Equal Opportunity Employer.

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.