Overview Job Title: Medication Prior Authorization Coordinator
Department: Specialty Pharmacy
Location: Dallas, TX
Shift: Monday-Friday, 8:00am-4:30pm
Job Type: On-Site
Join to apply for the Medication Prior Authorization Coordinator role at Children's Health . This position supports the Centralized Medication Prior Authorization Department by implementing standards, processes, and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities. The role serves as a technical expert and resource to staff and patients, ensuring appropriate levels of complex patient medication authorizations to facilitate efficient operations, expeditious reimbursement, and optimal customer service.
Childrens Health is dedicated to making life better for children, delivering exceptional patient and family experiences, and promoting community health through collaboration with UT Southwestern and broader partnerships.
Responsibilities Serve as preceptor for onboarding new team members to the department
Provide guidance, training, and feedback to staff on processes, payers, and systems; monitor work queues and assess productivity
Interpret and ensure compliance with performance standards, regulations, policies, procedures, and third-party contracts
Coordinate implementation of team-oriented process improvement initiatives
Resolve complex patient issues, respond to reimbursement questions, and serve as a resource to patient access specialists, including on-the-job training
Act as liaison to resolve complex patient medication authorization issues
Perform routine audits and quality assurance for staff
Clerical functions: manage phone lines, faxing, document receipt, medical records retrieval, document scanning, and related tasks
Collect insurance benefit information to determine coverage options and benefits
Communicate with patients, families, providers, multidisciplinary team members, and payers to coordinate submissions and approvals
Notify physicians and staff of additional information requested by payors to reduce delays (e.g., peer-to-peer, letters of medical necessity, signatures)
Demonstrate alignment with Children's Health System Vision, Mission and Values
Follow safety rules, report accidents, and address safety hazards
Perform other duties as assigned
Qualifications Ability to multitask, manage multiple authorizations, strong organizational and interpersonal skills
Typing speed of 65+ WPM
Professional, calm handling of challenging situations; strong written and verbal communication
Adaptability in a dynamic environment; quick learner, problem-solver, decision-maker
Work Experience At least 5 years of customer service experience with two years of healthcare experience including insurance verification and/or billing
Extensive knowledge of policies and guidelines used by health insurers, government agencies, and employer benefits departments related to medication prior authorizations
EPIC proficiency required
Education Two-year Associate's degree or equivalent experience
Licenses and Certifications National Association of Healthcare Access Management CHAA Certification (1 year preferred)
Benefits Employee portion of medical plan premiums covered after 3 years
4%-10% employee savings plan match based on tenure
Paid Parental Leave (up to 12 weeks)
Caregiver Leave
Adoption and surrogacy reimbursement
Equal Opportunity Children’s Health is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other federally- or state-protected status.