Prior Authorization Specialist

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharma’s Benefits

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

Job Summary

We are seeking a highly organized and detail-oriented Prior Authorization Coordinator to join our dynamic pharmacy team. This individual will play a key role in ensuring timely and accurate submission, follow-up, and approval of prior authorizations and appeals for medical and prescription services. This role supports patient care by minimizing delays in treatment and works closely with healthcare providers, insurance carriers, and internal teams.

Schedule Details

• Location: On-Site (Training in Orange, CA; position based in Laguna Hills, CA post-training)
• Hours: Monday to Friday, 8:30 AM – 5:00 PM

Duties and Responsibilities 

• Ensure timely, accurate submission, follow-up, and approval of prior authorizations for medications and medical services
• Review requests and documentation for completeness and accuracy; ensure all supporting materials are submitted
• Communicate with healthcare providers, insurance companies, patients, and internal teams to clarify and resolve authorization issues
• Assist in gathering and submitting documentation to support medical necessity appeals
• Proactively manage and track authorization requests, expirations, and renewals
• Document all interactions with stakeholders in the system clearly and consistently
• Log all prior authorization details (e.g., approval dates, billing units, procedure codes, authorization numbers) into the patient profile
• Collaborate with clinical, billing, and intake departments to coordinate and resolve outstanding authorization or billing issues
• Stay current on payer-specific guidelines and regulatory requirements regarding authorizations and appeals
• Maintain compliance with company policies, procedures, and applicable laws and standards
• Complete required daily, weekly, and monthly reports as assigned by leadership
• Perform other duties as assigned

Experience and Skills Requirements 

• Minimum of 2 years of experience in prior authorization, preferably in infusion services, specialty pharmacy, or a medical office
• Strong understanding of Medicare, Medicaid, and Managed Care reimbursement and prior authorization requirements
• Familiarity with medical terminology, insurance processes, and prescription medications
• Demonstrated ability to work in a fast-paced, high-volume environment and manage multiple priorities
• Strong analytical, critical thinking, and problem-solving skills
• Excellent verbal and written communication skills
• Intermediate-level proficiency in Microsoft Excel, Word, and experience with electronic health systems or pharmacy software
• High level of attention to detail and accuracy in documentation
• Ability to work independently and as part of a collaborative team

Preferred Qualifications

• Experience with appeals and insurance claim processing
• Prior experience working in a paperless workflow environment
• Experience with EMR, CPR+, or prior authorization platforms

AmeriPharma’s Mission Statement 

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements 

The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations

EEO Statement 

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.