Prior Authorization Specialist

Job Title:

Prior Authorization Specialist

Reports To:

Health Information and Care Coordination Manager

Location:

Grants Pass, Oregon – 557B NE Westbrook Way Hawthrone Ave. Grants Pass, OR, 97527

Job Type: Full TimeFLSA Status:
Non-Exempt Pay Range: $18.35-$25.00/hour

Schedule:

Monday-Friday 8:00 AM – 5:00 PM

Job Summary:

The Prior Authorization Specialist is responsible for coordinating and obtaining prior authorizations for medications and diagnostic imaging services, as well as processing imaging referrals. This role plays a key part in ensuring timely access to patient care by facilitating authorization requests, coordinating with insurance providers, and supporting an efficient referral process.

Essential Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Processes and monitors medication prior authorization requests through Cover My Meds  and other insurance authorization platforms.

Coordinates prior authorizations for diagnostic imaging services, ensuring timely submission of required documentation.

Processes and tracks imaging referrals, coordinating with providers, insurance companies, and imaging facilities to support timely patient care.

Reviews authorization requests for accuracy and completeness, obtaining additional clinical documentation as needed.

Communicates with providers and clinical staff regarding authorization requirements, pending requests, approvals, denials, and necessary follow-up.

Follows up with insurance companies to resolve authorization delays, documentation discrepancies, and outstanding requests.

Accurately documents prior authorizations, referral activities, and medication refill-related information in the Electronic Health Record (EHR).Maintains organized records and prioritizes requests to ensure timely processing and completion.

Ensures compliance with HIPAA regulations, patient confidentiality standards, and organizational policies.

Performs other duties as assigned..

Working Conditions:

Work Environment: 100% office-based position with continuous interaction with patients. Work is primarily conducted at a designated workstation utilizing computers, electronic health records, telephones, and other standard office equipment. Regular interaction with healthcare providers, clinical staff, insurance representatives, pharmacies, and external healthcare organizations is required. The position involves managing multiple requests and deadlines in a fast-paced healthcare environment while maintaining accuracy and attention to detail.

Travel Requirements:
Primarily office-based; occasional local travel may be required as needed.

Physical Demands:
Prolonged periods of sitting and working at a computer workstation. Frequent use of hands and fingers for typing, data entry, operating office equipment, and handling documents. Ability to stand, walk, sit, bend, reach, push, carry, and lift as required to perform job duties. Ability to maintain physical mobility throughout the office. Vision and hearing must be within functional range, with corrective devices as needed.

Qualifications Required

Education and Experience

Education:

High School Diploma or equivalent GED.

Experience:

Previous experience in a healthcare, medical office, pharmacy, or administrative support setting preferred.

Experience processing medication prior authorizations, insurance verification, medical referrals, or insurance-related documentation preferred.

Familiarity with Electronic Health Record (EHR) systems and healthcare documentation practices preferred.

Experience working with insurance companies, including Medicaid, Medicare, and commercial insurance plans, preferred.

Experience utilizing Cover My Meds  or similar prior authorization…