Position Overview:
We are seeking an experienced Prior Authorization Specialist with a strong background in handling high-volume authorizations for GLP-1 medications and endocrine/diabetes-related services. The ideal candidate is confident in communicating with providers, highly organized, and able to manage payer requirements efficiently and accurately.
Key Responsibilities:
● Process and manage a minimum of 30+ prior authorizations daily
● Handle prior authorizations for GLP-1 medications and endocrine/diabetes-related treatments
● Work directly with providers and clinical staff to obtain required documentation
● Communicate authorization updates, denials, and approvals clearly and professionally
● Submit and track authorizations through payer portals and pharmacy benefit systems
● Utilize CoverMyMeds and other authorization platforms to streamline workflows
● Maintain accurate and timely documentation in all systems
● Ensure all communications with providers are concise, accurate, and professional
Qualifications:
● Prior authorization experience with: Anthem, UnitedHealthcare, Aetna, Optum, Express Scripts, Cigna, Humana
● Strong experience handling GLP-1 medication authorizations
● Experience with endocrine and/or diabetes-related prior authorizations
● Experience using CoverMyMeds
● High-volume prior authorization processing experience
● Strong written and verbal communication skills
● Confident and professional when speaking with providers
● Ability to provide short, accurate, and effective communication to provider offices
● Strong attention to detail and organizational skills
● Ability to work independently in a fast-paced environment
Preferred Qualifications:
● Experience in specialty pharmacy, endocrinology, or diabetes-focused healthcare settings
● Familiarity with commercial payer authorization guidelines
