Prior Authorization Injectable Coordinator

Description

JOB SUMMARY

The Prior Authorization Injectable Coordinator is responsible for supporting the Utilization Management (UM) process by completing non-clinical prior authorization and injectable medication requests. This role ensures accurate data entry, verification of eligibility and benefits, timely follow-up, and effective communication with internal clinic staff, providers, and pharmacies, while maintaining compliance with NCQA standards, UM policies, and HIPAA regulations.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: High school diploma or equivalent.

Preferred: Medical terminology training or healthcare-related coursework.

Experience 

Minimum: Demonstrated administrative or office experience.

Preferred: 1+ years of experience in healthcare, medical management, or utilization review-related experience.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

· Strong service-oriented attitude with consistent professionalism and courtesy

· Ability to read, comprehend, and follow written and verbal instructions

· Effective written and verbal communication skills

· Ability to manage multiple priorities and meet productivity and accuracy standards

· Sound judgment when handling confidential and protected health information

· Working knowledge of Microsoft Word and Excel

· Familiarity with standard office equipment (phones, fax machines, copiers)

· Willingness and ability to learn new systems and software

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position primarily involves prolonged sitting with frequent use of a computer, telephone, and standard office equipment. Occasional standing, walking, bending, and light lifting (up to 20 pounds) are required. The role demands consistent hand and finger dexterity for typing and writing, limited overhead reaching, and periodic stair climbing.