Prior Authorization Coordinator

Independent Health

. Facilitate logging in and out of prior authorization, appeal, reimbursement and grievance requests .

Posted 9/23/2026full-timeBuffalo • New York • United StatesJunior💰 $22 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization processes, including logging, follow-up, and resolution of requests, while ensuring compliance with regulatory requirements. Proficient in pharmacy operations, with strong organizational skills and the ability to communicate effectively with providers and members.

Highest-signal resume keywords

Prior Authorization ExperiencePharmacy Operations KnowledgeWritten And Verbal Communication SkillsOrganizational And Time Management SkillsProblem-Solving Ability

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryEligibility VerificationReimbursement RequestsMedical Director TranscriptionStatistical MaintenanceDrug KnowledgeDosage CalculationsPharmacy Online System FamiliarityReport CompletionDocument Preparation

Soft Skills

CreativitySelf-MotivationAdaptability

Tools & Technologies

Pharmacy Systems

Certifications & Qualifications

High School DiplomaGEDAssociate's Degree (Preferred)

Industry Keywords

Prior AuthorizationHealth Insurance OperationsFormularyHMO ConceptPharmacy Medical Exception

About the role

Key responsibilities & impact

Facilitate logging in and out of prior authorization, appeal, reimbursement and grievance requests
Follow up on requests to ensure timely resolution and completion
Ensure process steps and regulatory requirements are completed
Address provider questions regarding formularies through the pharmacy medical exception line
Provide administrative support including faxing requests, completing decision letters, making notification calls, filing and document scanning preparation
Verify member and provider eligibility and file requests into correct member folders
Enter prior authorization request data and maintain accurate statistics in pharmacy systems
Enter overrides and update required documentation systems; transcribe Medical Director decisions when needed
Complete reports, reimbursement requests, IRO reviews and vendor email/report reviews
Make follow-up and outbound calls to members, providers and physicians regarding approvals, denials and decisions
Resolve provider and internal caller questions regarding formulary and prior authorization
Research and respond to escalated and complex pharmacy inquiries
Provide required letters within required timeframes
Fax, copy, mail and prepare completed requests for scanning
Maintain file storage according to corporate retention policy

Requirements

What you’ll need

High school diploma or GED required
Associate's degree preferred
Two (2) years of experience in pharmacy or health insurance operations required OR one (1) year of experience as a temporary associate in the Prior Authorization Coordinator role or Prior Authorization department required
Pharmacy experience strongly preferred
General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred
Familiarity with HMO concept
Experience with pharmacy online system preferred
Written and verbal communication skills
Excellent organizational and time management skills
Excellent ability to absorb new concepts and adapt to a changing environment
Creativity and self-motivation, with the ability to solve problems
Math aptitude for calculating simple drug requirements using dose and price calculations
Proven examples of displaying PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring
Must work occasional holidays, weekends and overtime
Immigration or work visa sponsorship will not be provided

Benefits

Comp & perks

Scorecard incentive eligibility
Full range of benefits
Generous paid time off
Career growth opportunities
First-class perks
Culture fostering growth, innovation and collaboration