About the role
Status: Hourly, Non-Exempt
Hourly Rate: $21.00 - $23.00
JOB 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 the Health Insurance Portability and Accountability Act (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.
QUALIFICATIONS AND REQUIREMENTS Previous Experience:
* 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.
Education:
* High School Graduate required, College degree preferred. * State Pharmacy Technician registration or PTCB National Certification preferred.
Physical Demands:
* Requires sitting, standing, and occasional light lifting.
This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our website for more information about our benefits list.
ProMod Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at .
ProMod Rx is an Equal Opportunity Employer.
Originally posted on Himalayas