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.
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