Prior Authorization Support Specialist

Position Overview:

The Prior Authorization Support Specialist is responsible for facilitating and supporting the prior authorization (PA) process to ensure timely access to medications and medical services. This role serves as a liaison between healthcare providers, payers, and internal utilization management teams to coordinate submissions, track requests, and ensure compliance with payer requirements.

About MedOne:

MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.

What You Will Do at MedOne:

Support operations of MedOne Clinical Service

Provide direct assistance to members seeking support throughout the prior authorization process

Assist in the submission, tracking, and follow-up of prior authorization requests for medications and/or medical services

Review documentation for completeness and accuracy prior to submission to health plans or pharmacy benefit managers (PBMs)

Communicate with prescribers, provider offices, pharmacies, and payers to obtain required clinical information

Monitor authorization status and ensure timely resolution of pending or denied requests

Support appeals and reconsideration processes by gathering necessary clinical documentation

Complete Proactive Prescriber Outreach Program (PPOP) calls to prescribers utilizing PPOP resources provided by the Clinical Operations team

Maintain accurate and up-to-date records in electronic systems

Identify and escalate urgent or complex cases as appropriate

Ensure compliance with regulatory requirements, payer policies, and internal procedures

Provide updates and status reports to internal stakeholders as needed

Assist with audits and quality assurance activities related to prior authorization workflows

Works to promote a team environment

Support the operation and maintenance of existing MedOne Clinical Services

Assists and supports members of MedOne Pharmacy Benefit Solutions

Portrays the company in a positive image

Required to abide by all rules, regulations and policies of the employer

Other duties as assigned

What you will bring to MedOne:

High school diploma or equivalent (Associate’s or Bachelor’s degree preferred)

1–3 years of experience in healthcare, pharmacy, insurance, or prior authorization support

Basic understanding of pharmacy or medical terminology

Familiarity with prior authorization processes, claims, or payer requirements

Strong attention to detail and organizational skills

Excellent communication (verbal and written) and customer service skills

Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint)

Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus

Must be able to type at a minimum of 30 words per minute

Must be able to work independently, meets deadlines, establish priorities, and be flexible

Must be able to stand/sit for long periods of time within limited space

Must be able to lift up to 25 pounds

Must be able to work cooperatively with MedOne staff

Ability to manage multiple tasks and meet deadlines in a fast-paced environment

Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees)

Why Join MedOne?

Competitive salary and bonuses that reward your performance

Comprehensive health, dental, and vision insurance

401(k) with company match to secure your future

Generous paid time off and holidays

Opportunities for professional growth and development

A vibrant and collaborative work culture

Location: We have offices in either Dubuque, IA, or Kansas City, MO, or the position can be remote within the United States

Employment Type: Full-Time, Hourly/Non-Exempt

Hours: Hours may vary within our normal business hours

How to Apply: If you're enthusiastic about helping others and eager to join a dynamic team, we’d love to hear from you. Apply now and take the first step toward a rewarding career at MedOne! You can submit your application through our careers page.

MedOne is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Job Offers are contingent on passing a background check and drug screen.