Prior Authorization Coordinator

Florida Urology Partners

Job Description

Job Title: Prior Authorization Coordinator Status: Non-Exempt 

Department: In-Office Dispensary Division: Oncology Division

Directly Reports to: Director, Prescription Programs Revision Date: July 2025

Position Summary:

The Prior Authorization Coordinator, Prescription Programs, is responsible for obtaining and managing prior authorizations for oncology and urology medications primarily administered under the “buy and bill” model. This role ensures timely patient access to treatment, supports accurate reimbursement, and coordinates closely with internal and external stakeholders including IOD (In-Office Dispensing) staff, office personnel, and patients.

Key Responsibilities:

1. Prior Authorization Management

• Initiate, submit, and manage prior authorization requests for oncology and other medications and therapies under the patient’s medical benefit.
• Collect necessary clinical documentation from providers and upload or transmit to insurance payers.
• Track and follow up on pending authorizations to ensure timely approval.

2. Communication & Coordination

• Work collaboratively with IOD staff, providers, front desk and billing team members to ensure seamless medication scheduling and delivery.
• Communicate with patients regarding status, financial responsibility, and any required paperwork or consents.
• Assist with copay support programs, patient assistance enrollment, and payment collections, working in collaboration with front-desk and billing teams.

3. Payer & Reimbursement Support

• Engage with insurance payers to resolve issues or provide additional information needed for authorizations.
• Remain current on payer-specific policies related to oncology/urology medications and the buy and bill process.
• Partner with revenue cycle and billing staff to prevent and address denied claims related to prior authorization.

4. Documentation & Compliance

• Maintain accurate, up-to-date records in the EMR and prescription billing and information systems.
• Ensure all activities comply with HIPAA and relevant payer or regulatory requirements.
• Assist in reporting and audits as needed.

Florida Urology Partners is committed to diversity and does not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics 

• High school diploma or equivalent required; Associate’s degree required.
• 2+ years of experience with prior authorization in a medical or oncology setting required.
• Knowledge of oncology/urology medications, buy and bill workflows, and insurance guidelines required.
• Experience with EMR systems and payer portals (e.g. Cover My Meds).
• Strong interpersonal and communication skills with both clinical and non-clinical teams.

Preferred Skills:

• Experience working with IOD operations or specialty pharmacy services.
• Certified Pharmacy Technician (CPhT), Medical Assistant (MA), or billing/coding certification.
• Familiarity with HCPCS/CPT codes and infusion billing practices.