Prior Authorization Specialist - Patient Access & Care

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

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.