Prior Authorization & Appeals Coordinator

Job Title: Coordinator I, Prior Authorization & Appeals
Duration 6 Months
Location work from home

Position Summary:
The Coordinator I, Prior Authorization & Appeals, is responsible for performing non-clinical activities and support functions in accordance with established policies, procedures, and regulatory requirements. Working under the supervision of the Clinical Supervisor, this role ensures compliance with ERISA, CMS, Medicaid, and client-specific standards. The Coordinator contributes as part of a team to meet business unit objectives while maintaining service level agreements and delivering excellent customer support.

Key Responsibilities:

• Sort and process incoming faxes and mail in compliance with department and client requirements.

• Ensure accurate and timely completion of transactions to meet or exceed client service level agreements.

• Review and maintain compliance with ERISA, CMS, Medicaid, and client-specific requirements.

• Collaborate with team members to support operational goals and client expectations.

• Perform data entry and documentation tasks with accuracy and attention to detail.

Required Experience:

• Minimum of 6 months to 1 year of data entry experience.

• Proficiency in Windows applications (Word and Excel).

• Strong problem-solving, analytical, written communication, and interpersonal skills.

• Ability to type 25 30 WPM.

• Highly detail-oriented with excellent organizational skills.

Preferred Experience:

• 1 year of experience in the healthcare industry (hospital, managed care, physician office, PBM, etc.).

• Knowledge of prescription drug products, dosage forms, and usage.

• Background in medical and/or pharmacy terminology.

Education:

• High school diploma or GED required.

Schedule:

• Work hours: Monday Friday, between 7:00 AM 8:00 PM CT (shifts may vary).

• Training schedule: 8:00 AM 4:30 PM CT.