Prior Authorization & Referral Specialist Medications

Role & responsibilities

• Process medication prior authorizations using CoverMyMeds and payer portals.
• Review patient records, clinical documentation, and insurance requirements.
• Follow up on pending, approved, and denied authorizations.
• Coordinate patient referrals and track referral status through completion.
• Communicate with insurance companies, provider offices, specialists, and patients.
• Maintain accurate documentation in EHR systems and tracking tools.
• Ensure HIPAA compliance and data confidentiality.

Preferred candidate profile

• 1+ year of experience in Prior Authorization, Referral Coordination, or Healthcare RCM.
• Experience with CoverMyMeds, EHR systems, and payer portals.
• Knowledge of medication authorization workflows and insurance processes.
• Strong communication, organizational, and follow-up skills.
• Familiarity with HIPAA and healthcare documentation standards.