Authorization Coordinator

• Report any misconduct, suspicious, or unethical activities to the Compliance Officer
• Verify insurance eligibility and benefits
• Obtain referrals and complete required notifications and payor forms
• Submit pharmacy and medical insurance pre-authorizations via fax, payer portal, or telephone
• Process authorization requests for: New referrals, Order changes, Insurance updates, Ongoing long-term therapies
• Coordinate with internal teams, providers, and external customers to obtain additional information for authorization requests
• Track and follow up on all appeal and authorization submissions according to departmental policy and insurance payer requirements
• Communicate approvals, denials, appeal options, and ongoing status to pharmacy staff, billing, healthcare team, customers, and supervisors
• Review home infusion orders and medical documentation for accuracy
• Handle incoming and outgoing calls related to the authorization/appeal process
• Collaborate with providers and internal teams to address denials or gather alternative documentation
• Report recurring payer issues, trends, or changes to the supervisor
• Cross-train within the department to ensure smooth workflow and coverage
• Ensure all tasks are performed accurately, efficiently, and within required timeframes to meet departmental and insurance guidelines
• Maintain HIPAA compliance and participate in ongoing training as required
• Understand and comply with all applicable company policies and procedures
• Perform other duties as directed by management

• High school diploma or general education degree (GED)
• Minimum of 1 year of related experience in medical insurance authorization and/or training
• Proficiency in basic math skills is required for this position
• Computer skills required: Google software (Docs
• Drive
• Sheets)
• Experience in home infusion pharmacy preferred, not required

Experience in home infusion pharmacy