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Prior Authorization Associate Jobs in New York (NOW HIRING)

Astera

Patient Access Coordinator

East Brunswick, NJ · On-site +1

$22/hr

Communicate payer determinations, prior authorization requirements, denials, approvals, and ... Associate degree in healthcare administration, business, pharmacy, or related field preferred.

Astera

Patient Access Coordinator

East Brunswick, NJ · On-site

$22 - $28/hr

Communicate payer determinations, prior authorization requirements, denials, approvals, and ... Associate degree in healthcare administration, business, pharmacy, or related field preferred.

Highmark Health

Pharmacy Coordinator

New York, NY · On-site

Review of prior authorization criteria for drug products. * Recommend staffing adjustments ... Associate degree * Pharmacy technician certification certificate * Experience working in a managed ...

Highmark Health

Pharmacy Coordinator

New York, NY · On-site

Review of prior authorization criteria for drug products. * Recommend staffing adjustments ... Associate degree * Pharmacy technician certification certificate * Experience working in a managed ...

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All JobsPrior Authorization Associate JobsPrior Authorization Associate Jobs in New York

Prior Authorization Associate information

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

What are the key skills and qualifications needed to thrive as a prior authorization associate?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What is a prior authorization associate?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are some common challenges faced by a prior authorization associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.

What are the most commonly searched types of Prior Authorization jobs in New York?

The most popular types of Prior Authorization jobs in New York are:

What are popular job titles related to Prior Authorization Associate jobs in New York?

For Prior Authorization Associate jobs in New York, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Associate jobs in New York look for?

The top searched job categories for Prior Authorization Associate jobs in New York are:

What cities in New York are hiring for Prior Authorization Associate jobs?

Cities in New York with the most Prior Authorization Associate job openings:

Prior Authorization Associate jobs near you

Patient Access Coordinator

Astera

East Brunswick, NJ • On-site, Remote

$22/hr

Full-time

Medical

Re-posted 8 days ago

Job description

Why Join Us?

For us, what matters most is excellence. We are caring professionals, people who live, work and dedicate themselves to the communities within New Jersey and Pennsylvania. As such, we strive to provide a sanctuary of excellence, precision, thoroughness and genuine compassion. We also take a whole-person approach to patient care and treatment, tailoring all that we do around their unique needs. And we do all we can for patients, going the extra mile to see that they're supported, informed and getting the one-on-one care and service they deserve.

Job Description:

SCOPE:

The Patient Access Coordinator serves as a key liaison among patients, healthcare providers, payers, and internal pharmacy teams to facilitate timely access to prescribed medications. This role is responsible for managing and monitoring prescriptions throughout the medication access process, including prescription intake, insurance verification, prior authorization coordination, payer determination follow-up, and patient communication. This position is eligible for hybrid schedule. Pharmacy experience preferred.

The Patient Access Coordinator proactively communicates prescription status updates, payer requirements, and authorization outcomes to providers and patients while ensuring all documentation is accurately maintained. This position supports operational efficiency, enhances patient experience, and helps remove barriers to medication access.

Essential Duties and Responsibilities:

  • Monitor and manage prescriptions throughout the medication access and fulfillment process.
  • Serve as the primary point of contact for patients regarding prescription status, insurance requirements, and next steps.
  • Communicate payer determinations, prior authorization requirements, denials, approvals, and requests for additional information to prescribing providers.
  • Coordinate with prior authorization teams, healthcare providers, patients, and pharmacy staff to facilitate timely prescription processing.
  • Track and follow up on outstanding prior authorizations, appeals, and payer requests.
  • Document all patient, provider, and payer interactions accurately and timely within designated systems.
  • Verify prescription information and ensure all required documentation is complete and compliant.
  • Escalate complex medication access issues to appropriate clinical or operational personnel.
  • Assist patients in understanding medication access processes and provide updates throughout the prescription lifecycle.
  • Collaborate with internal teams to identify and resolve barriers to medication access.
  • Maintain confidentiality and safeguard protected health information in accordance with HIPAA and organizational policies.
  • Meet established productivity, quality, and service standards.
  • Participate in departmental meetings, training, and continuous improvement initiatives.
  • Perform other duties as assigned.

Requirements:

Education

  • High school diploma or equivalent required.
  • Associate degree in healthcare administration, business, pharmacy, or related field preferred.

Experience/Knowledge

  • Minimum of 1-2 years of experience in a healthcare, pharmacy, medical office, patient access, or insurance-related environment preferred.
  • Experience working with prior authorizations, pharmacy benefits, medical benefits, or insurance verification.
  • Experience communicating with healthcare providers and patients.
  • Knowledge of healthcare insurance processes, prior authorizations, and medication access workflows.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Work is generally performed in an office environment; however, this position offers the opportunity to work hybrid, with telework arrangements available upon approval.

Pay Range: $22/hr - $28/hr

Pay Transparency: The above reflects the anticipated pay range for this position. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

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