Medication Authorization Specialist

Position Summary

The Medication Refill & Prior Authorization Coordinator is responsible for coordinating medication refill requests and completing prior authorizations to help ensure patients have timely access to prescribed medications. This role works closely with patients, providers, pharmacies, and insurance companies to facilitate refill requests, resolve medication authorization issues, and communicate updates regarding prescription status.

The ideal candidate is organized, dependable, detail-oriented, and comfortable managing a high volume of requests while maintaining accuracy and patient confidentiality.

Key Duties and Responsibilities

Medication Refill Coordination

• Receive and process incoming medication refill requests.
• Review refill requests for completeness and route them to the appropriate provider for review and approval.
• Communicate with pharmacies, patients, and clinical staff regarding refill requests and prescription status.
• Follow up on pending refill requests to help ensure timely resolution.
• Maintain accurate documentation of refill requests and related communications in the patient record.

Medication Prior Authorizations

• Initiate and complete insurance prior authorizations for prescribed medications.
• Submit required clinical and insurance information to insurance companies and pharmacy benefit managers.
• Track pending medication authorizations and follow up with payers as needed.
• Communicate authorization approvals, denials, and requests for additional information to the appropriate provider or clinical staff.
• Assist with authorization renewals for medications requiring continued insurance approval.
• Help troubleshoot insurance coverage issues that may delay patients from receiving their medications.

Patient, Pharmacy & Provider Communication

• Serve as a point of contact for medication refill and authorization questions.
• Communicate professionally and compassionately with patients regarding the status of their requests.
• Coordinate with pharmacies regarding refill issues, insurance requirements, and authorization status.
• Work closely with providers and clinical staff to obtain information needed to complete requests.

Documentation & Compliance

• Maintain accurate and timely documentation in the electronic medical record and other applicable systems.
• Protect patient confidentiality and maintain compliance with HIPAA requirements.
• Follow organizational policies and procedures when handling patient and medication information.
• Maintain organized records of outstanding requests and follow-up needs.

Other Duties

• Assist with related administrative responsibilities as needed.
• Perform other duties as assigned.

Qualifications

Education

• High school diploma or equivalent required.

Experience

• Previous experience in a healthcare, behavioral health, pharmacy, medical office, or similar setting preferred.
• Experience processing medication prior authorizations or prescription refill requests strongly preferred.
• Experience communicating with insurance companies and pharmacies is a plus.

Core Competencies

• Attention to Detail: Maintains accuracy when processing medication and insurance information.
• Organization: Effectively manages multiple refill and authorization requests simultaneously.
• Follow-Through: Tracks outstanding requests through completion and follows up appropriately.
• Communication: Communicates clearly and professionally with patients, providers, pharmacies, and insurance companies.
• Problem Solving: Works through routine medication coverage and authorization issues efficiently.
• Confidentiality: Handles protected health information appropriately and follows HIPAA requirements.
• Teamwork: Collaborates effectively with providers, clinical staff, pharmacies, and administrative teams.

Work Environment

This is a full-time, 40-hour-per-week, in-office position and may work from any of the five designated practice locations.

• St. Petersburg, FL
• Brandon, FL
• Palm Harbor, FL
• Wesley Chapel, FL
• Tampa, FL

Benefits

• 401(k)
• 401(k) matching
• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Employee assistance program
• Employee discount