Prior Authorization Specialist - Patient Access Liaison

ProMod Rx; Gainesville (GA); On-site; USD 52,000 - 68,000; Full time

Job summary

ProMod Rx is seeking a dedicated Prior Authorization Coordinator to manage end-to-end PA requests for manufacturer-sponsored patient access programs. You will coordinate with prescribers, pharmacies, and payers to move cases from benefits verification through authorization and therapy initiation.

The role requires 3+ years in pharmacy/healthcare, strong medical terminology knowledge, and excellent communication. Bilingual in English/Spanish is a plus. On-site position with benefits.

Qualifications

• 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.
• High School Graduate required, College degree preferred.
• State Pharmacy Technician registration or PTCB National Certification preferred.
• Requires sitting, standing, and occasional light lifting.

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 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.

Skills

Prior authorization

Healthcare experience

Bilingual English/Spanish

MS Office & data entry

Communication skills

Education

State Pharmacy Technician registration

PTCB Certification

High School Diploma

Tools

CRM system

Data entry

Job description

ProMod Rx is seeking a dedicated Prior Authorization Coordinator to manage end-to-end PA requests for manufacturer-sponsored patient access programs. You will coordinate with prescribers, pharmacies, and payers to move cases from benefits verification through authorization and therapy initiation.

The role requires 3+ years in pharmacy/healthcare, strong medical terminology knowledge, and excellent communication. Bilingual in English/Spanish is a plus. On-site position with benefits.