Medication Prior Authorization Specialist

Medication Prior Authorization Specialist CoreLife - 2.3 Winston-Salem, NC Job Details Full-time 4 days ago Qualifications Collaborate with healthcare professionals Appeals Insurance prior authorization Achieving HIPAA compliance Maintaining patient confidentiality Insurance claim appeals processing HIPAA Process improvement Mid-level Patient service State healthcare regulations Customer inquiry handling Medical insurance appeals management CRM system proficiency Managing patient records Cross-functional communication

Full Job Description 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.