Centralized Medication Prior Authorization Specialist at ANGEL KIDS PEDIATRICS, P A – Jacksonville, Florida

Centralized Medication Prior Authorization Specialist
Reports to: Chief Quality & Compliance Officer
Area of Interest: CMA, MA, or LPN
FTE/Hours per Pay Period: 1.0 (Full-time)
Department: Quality Improvement
Shift: Monday – Friday, 8:00 a.m. – 5:00 p.m.
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Summary
As the largest pediatric clinic in Jacksonville, serving 10 locations with nearly 45,000 patients, Angel Kids Pediatrics believes that caring for children is a continual process that should not be limited to doctor office visits during regular business hours.
We believe that by providing excellent medical care in a family- and community-based environment, we can grow healthy children who will become healthy adults. We uphold the highest standards of a patient-centered medical home, providing quality, personalized, and effective medical care as if each family were part of our own.
Equity, innovation, and inclusion guide our growth and strategy. We are seeking individuals who are passionate about providing culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment.
This is a full-time, office-based position with benefits, located at our corporate office in Jacksonville.
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Overview
The Centralized Medication Prior Authorization Specialist (Clinical) is responsible for obtaining timely prior authorizations for medications to ensure uninterrupted patient care. This role supports physicians, providers, and clinical team members across all Angel Kids Pediatrics clinics by navigating insurance requirements and improving patient access to necessary medications.
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Duties and Responsibilities
• Coordinate and process prior authorization requests for prescription medications and injections.
• Review clinical documentation to ensure completeness and compliance with payer requirements.
• Review and receive diagnostic results; alert appropriate stakeholders under provider direction; upload results into the EMR and document conversations in patient records.
• Track and follow up on pending authorizations to ensure timely approvals or appeals.
• Assist with appeals and denials, including gathering supporting documentation.
• Document all authorization activities in the Electronic Medical Record (EMR).
• Educate clinic staff on payer-specific requirements and changes in authorization policies.
• Maintain up-to-date knowledge of insurance plans, formularies, and coverage criteria.
• Monitor and report on authorization trends and denials to support process improvement initiatives.
• Collaborate with clinical teams to ensure timely submission of accurate and complete prior authorization requests, minimizing delays in care.
• Work as an extension of the clinical care team to support excellent patient and provider experience.
• Contribute to the development and maintenance of standard operating procedures for prior authorization workflows.
• Establish effective communication with staff, physicians, advanced practice practitioners, and patients.
• Serve as a liaison between providers, patients, insurance companies, and leadership for prior authorization expertise.
• Monitor clinical outcomes and patient satisfaction to ensure the highest level of care delivery.
• Collaborate with interdisciplinary teams to coordinate comprehensive care and continuously improve prior authorization processes.
• Assist with special projects and other duties as assigned by supervisor or manager.
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Preferred Education and Experience
• Graduate of an accredited program for Medical Assistants (preferred).
• 3–5 years of experience as a Certified Medical Assistant may be considered if a graduate from a non-accredited program.
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Licenses/Certifications
• Current CMA certification from AAMA, NCCT, AMT, or NHS (preferred).
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Competencies
• Teamwork
• Responsibility and accountability
• Decision-making skills
• Effective communication
• Leadership and initiative
• Trustworthiness and ethical conduct
• Ability to multitask
• Time management
• Attention to detail
• Exceptional customer service skills
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Equal Employment Opportunity
Angel Kids Pediatrics is committed to providing equal employment opportunity to all employees and applicants and does not discriminate on any basis prohibited by law, including race, color, sex, age, religion, ancestry, national origin, marital status, veteran status, or other legally protected status.
Equal opportunity applies to all employment practices, including recruitment, selection, compensation, benefits, promotion, demotion, layoff, termination, and all other terms and conditions of employment.
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Work Environment
This position operates in a professional office environment. It is fast-paced and customer-service oriented, supporting clinicians, staff, and patients across all clinics. The role routinely uses standard office equipment such as computers and laptops.
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Physical Demands
While performing the duties of this job, the employee may occasionally be required to stand, walk, sit, use a keyboard, handle or feel objects or controls, and reach with hands and arms. The employee may also balance, stoop, or kneel.
The employee must occasionally lift or move up to 20 pounds. The work environment may include exposure to bloodborne and airborne pathogens or infectious materials and occasional loud noise typical of pediatric clinics.
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Position Type / Expected Hours of Work
• Full-time position
• Monday – Friday: 8:00 a.m. – 5:00 p.m.
• Weekend or holiday work may be required occasionally for project support or special initiatives
This is primarily a centralized office-based role; no regular travel is required.