07/24/2026
Job Title: Prior Authorization Specialist – Medication Requests & Refills (Remote)
About the Role
We are seeking an experienced Prior Authorization Specialist with a strong background in medication prior authorizations, prescription requests, and medication refills. The ideal candidate is knowledgeable in working with insurance companies, pharmacy benefit managers (PBMs), and healthcare providers to ensure timely medication approvals while minimizing delays in patient care.
This position requires excellent attention to detail, strong communication skills, and the ability to manage multiple authorization requests in a fast-paced healthcare environment.
Key Responsibilities
• Process and submit medication prior authorization requests to commercial insurance plans, Medicare, Medicaid, and PBMs.
• Follow up with insurance companies regarding authorization status and resolve pending requests.
• Complete electronic prior authorizations (ePA) through payer portals and EMR/EHR systems.
• Review insurance requirements and gather necessary clinical documentation to support medication approvals.
• Coordinate with providers to obtain additional medical records, chart notes, or clinical information required by payers.
• Manage medication refill requests according to provider protocols and ensure timely processing.
• Communicate approval, denial, and appeal outcomes to providers, pharmacies, and patients.
• Submit appeals and reconsideration requests for denied medication authorizations.
• Maintain accurate documentation of all authorization activities within the EMR.
• Collaborate with pharmacies to resolve prescription processing issues and medication access concerns.
• Monitor authorization expiration dates and obtain renewals when necessary.
• Ensure compliance with HIPAA and all healthcare privacy regulations.
Qualifications Required:
• Minimum of 2 years of experience as a Prior Authorization Specialist focusing on medication authorizations.
• Strong knowledge of prescription prior authorization workflows.
• Experience handling medication refill requests.
• Experience working with commercial insurance, Medicare, Medicaid, and PBMs.
• Familiarity with electronic prior authorization (ePA) platforms.
• Experience with EMR/EHR systems such as Athenahealth, eClinicalWorks (eCW), Epic, NextGen, DrChrono, Kareo, or similar.
• Excellent verbal and written English communication skills.
• Strong organizational skills with the ability to prioritize multiple requests.
• High level of accuracy and attention to detail.
Preferred:
• Experience in specialty medications, biologics, or high-cost therapies.
• Knowledge of CoverMyMeds, Surescripts, Availity, or other authorization platforms.
• Experience in specialty pharmacy or ambulatory clinic settings.
• Medical billing or healthcare administrative experience is a plus.
Skills
• Medication Prior Authorization
• Medication Refill Management
• Insurance Verification
• PBM Coordination
• Appeals and Denial Management
• Prescription Workflow
• EMR/EHR Documentation
• Time Management
• Critical Thinking
• Customer Service
• HIPAA Compliance
What We Offer
• Competitive salary
• Permanent remote work opportunity
• Career growth opportunities
• Collaborative and supportive team environment
If you have a passion for helping patients gain timely access to their medications and possess strong experience in medication prior authorizations and refill management, we'd love to hear from you. Apply today and become part of a team dedicated to delivering exceptional healthcare support.
📩 APPLY NOW and start your journey with us!
📩 Fill out this form to apply!
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