Prior Authorization Support Specialist

MedOne Pharmacy Benefit Solutions; Dubuque (IA); On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Competitive salary

Health, dental, vision insurance

401(k) with company match

Generous paid time off

Professional growth opportunities

Job summary

MedOne Pharmacy Benefit Solutions is seeking a Prior Authorization Support Specialist to facilitate PA submissions and liaise with providers, payers, and internal teams. You will monitor statuses, gather clinical information, and help with appeals to ensure timely access to medications and services.

The role requires PA knowledge, attention to detail, and strong communication skills to support members and prescribers in a fast-paced environment.

Qualifications

• High school diploma or equivalent required; additional degrees preferred.
• CPhT certification or state equivalent required at start date.
• 1–3 years in healthcare, pharmacy, insurance, or PA support.
• Basic pharmacy/medical terminology understanding.
• Familiarity with PA processes, claims, or payer requirements.

Responsibilities

• Facilitate and support prior authorization submissions.
• Coordinate with providers, payers, and internal teams.
• Review documentation for completeness prior to submission.
• Monitor PA status and respond to denials or requests for info
• Assist with appeals and reconsideration documentation
• Maintain accurate records in electronic systems

Skills

CPhT certification

Attention to detail

Strong communication

Customer service

Multitasking

Education

High School Diploma or equivalent

Associate’s or Bachelor's degree preferred

Tools

Microsoft Office (Word, Excel, PowerPoint)

Microsoft Dynamics CRM

Job description

The Prior Authorization Support Specialist is responsible for facilitating and supporting the prior authorization (PA) process to ensure timely access to medications and medical services. This role serves as a liaison between healthcare providers, payers, and internal utilization management teams to coordinate submissions, track requests, and ensure compliance with payer requirements.

About MedOne:

MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.

What You Will Do at MedOne:

• Support operations of MedOne Clinical Service
• Provide direct assistance to members seeking support throughout the prior authorization process
• Assist in the submission, tracking, and follow-up of prior authorization requests for medications and/or medical services
• Review documentation for completeness and accuracy prior to submission to health plans or pharmacy benefit managers (PBMs)
• Communicate with prescribers, provider offices, pharmacies, and payers to obtain required clinical information
• Monitor authorization status and ensure timely resolution of pending or denied requests
• Support appeals and reconsideration processes by gathering necessary clinical documentation
• Complete Proactive Prescriber Outreach Program (PPOP) calls to prescribers utilizing PPOP resources provided by the Clinical Operations team
• Maintain accurate and up-to-date records in electronic systems
• Identify and elevate urgent or complex cases as appropriate
• Ensure compliance with regulatory requirements, payer policies, and internal procedures
• Provide updates and status reports to internal stakeholders as needed
• Assist with audits and quality assurance activities related to prior authorization workflows
• Works to promote a team environment
• Support the operation and maintenance of existing MedOne Clinical Services
• Assists and supports members of MedOne Pharmacy Benefit Solutions
• Portrays the company in a positive image
• Required to abide by all rules, regulations and policies of the employer
• Other duties as assigned

What you will bring to MedOne:

• CPhT certification, or state equivalent at date of hire
• High school diploma or equivalent (Associate's or Bachelor's degree preferred)
• 1-3 years of experience in healthcare, pharmacy, insurance, or prior authorization support
• Basic understanding of pharmacy or medical terminology
• Familiarity with prior authorization processes, claims, or payer requirements
• Strong attention to detail and organizational skills
• Excellent communication (verbal and written) and customer service skills
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment
• Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees)
• Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint
• Familiarity with data entry software or CRM systems (Microsoft Dynamics) preferred
• Must be able to type at a minimum of 30 words per minute
• Must be able to work independently, meets deadlines, establish priorities, and be flexible
• Must be able to stand/sit for long periods of time within limited space
• Must be able to lift up to 25 pounds
• Must be able to work cooperatively with MedOne staff

Why Join MedOne?

• Competitive salary and bonuses that reward your performance
• Comprehensive health, dental, and vision insurance
• 401(k) with company match to secure your future
• Generous paid time off and holidays
• Opportunities for professional growth and development
• A vibrant and collaborative work culture