Prior Authorization Specialist (Diabetes Clinic | Epic EMR)

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