Benefits:- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
In a neurology practice, a
Prior Authorization Coordinator is responsible for obtaining insurance authorizations for medications, specialty drugs, infusions, and related therapies. This position works closely with providers, clinical staff, pharmacies, patients, and insurance companies to ensure timely approval of prescribed treatments while maintaining compliance with payer requirements and organizational policies.
Key Responsibilities: Prior Authorization & Insurance Coordination
· Submit and track medication prior authorization requests through insurance portals, fax, phone, and electronic medical record systems· Serve as the primary coordinator for Botox prior authorizations, ensuring timely approvals and continuity of patient treatment plans
· Obtain and verify insurance benefits, eligibility, and pharmacy coverage information· Collect and submit required clinical documentation, laboratory results, progress notes, and supporting medical records
· Monitor authorization status and follow up with insurance companies to prevent delays in patient care
· Prepare and submit prior authorization appeals and reconsideration requests when coverage is denied
· Communicate authorization approvals, denials, and coverage updates to providers, pharmacies, infusion centers, and patients
· Assist patients with copay assistance programs, manufacturer patient assistance programs, and specialty pharmacy coordination when applicable
· Collaborate closely with physicians, clinical staff, pharmacies, and insurance companies to support continuity of care and timely treatment initiation· Coordinate with providers regarding payer requirements, formulary alternatives, and appeal recommendations
· Maintain and manage medication sample inventory, tracking, documentation, and distribution in compliance with clinic and pharmaceutical guidelines
Documentation & Compliance
· Maintain accurate documentation of authorization activity within the electronic medical record (EMR)· Adhere to HIPAA and insurance compliance standards, payer regulations, and organizational policies· Manage complex insurance authorizations, appeals, denials, peer-to-peer reviews, and reimbursement coordination across multiple payers
· Serve as a subject matter expert on healthcare regulations, payer requirements, and prior authorization policies
Qualifications & Skills- Extensive experience in prior authorization, utilization management, or managed care, preferably in neurology or specialty care
- Strong leadership, organizational, and analytical skills to manage multiple requests and optimize revenue cycle performance
- Strong customer service, excellent organizational and time management abilities, attention to detail, and the ability to multi-task
- Other duties as assigned
Benefits
- Medical, Dental, and Vision insurance
- Paid Time Off
- 401(k) Retirement Plan
- Great Work Environment