Medication Prior Authorization Specialist

Linthicum Heights, MD

Full Time

Mid Level

About CoreLife:
CoreLife is a patient-centered healthcare organization focused on transforming lives by addressing the root causes of obesity and related chronic conditions. Our unique model combines clinical care, nutrition, exercise, and behavioral health to help patients achieve lasting results. We are growing rapidly and looking for passionate individuals who want to make a real impact.

Position Overview:
We are seeking a Medication Prior Authorization Specialist to join our growing team. This role plays a key part in supporting CoreLife’s providers and patients in securing access to prescribed medications for obesity treatment. You will serve as the subject matter expert on insurance-specific plan requirements and help navigate prior authorization processes for commercial and government payers.

Key Responsibilities:

Partner with providers and internal teams to ensure seamless patient care.
Review and process medication refills and prior authorizations in compliance with state and federal regulations.
Assist patients with accessing manufacturer coupons and completing medication assistance applications.
Closely monitor all prior authorization requests and ensure timely submission of all necessary documentation.
Coordinate follow-up actions and submit appeals for denied authorizations when appropriate.
Maintain accurate records in the CRM system and ensure PHI is secured in compliance with HIPAA.
Respond promptly to patient and insurance inquiries via phone or email.
Collaborate cross-functionally with departments to verify medication benefits.
Provide excellent customer service and contribute to continuous process improvements.
Meet turnaround time and quality performance standards.

Qualifications:

Pharmacy Technician, LPN, Medical Assistant, or a minimum of 2 years’ experience in medication prior authorization or a similar role
PTCB certification preferred

Skills & Competencies:

Strong knowledge of generic and brand-name medications, dosage, and administration
Excellent written and verbal communication skills
Organized, detail-oriented, and able to multitask in a fast-paced environment
Basic proficiency with technology and software systems
Ability to work both independently and collaboratively
Demonstrated commitment to patient care and confidentiality

Note: reasonable accommodations may be made available for individuals with disabilities to perform the essential functions of this position.

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