Lead Prior Authorization Specialist
Blue Ridge Health•Hendersonville, NC
•Onsite
About The Position
Blue Ridge Health is currently seeking a Lead Prior Authorization Specialist to be part of our Medical team in Hendersonville, NC. The Lead Prior Authorization Specialist serves as a subject matter expert for the prior authorization process of pharmaceutical and imaging orders, ensuring timely and accurate submission and follow-up of the authorization requests. This role provides training, guidance, and ongoing support to the team members and providers, while helping maintain workflow efficiency and compliance with payer requirements.
Requirements
- High School Diploma or equivalent, required
- Current North Carolina Pharmacy Technician, required
- Strong knowledge of pharmacy terminology
- Proficiency in MS Office programs required
Nice To Haves
- Experience working in an interdisciplinary and/or integrative health care model
- Familiarity with Electronic Health Records (EHR) and other databases, preferred.
Responsibilities
- Trains new and existing staff on prior authorization workflows, systems (CoverMyMeds, payer portals), and best practices
- Assists new staff with required portal set-up
- Provides ongoing education related to payer updates, process changes, and documentation requirements
- Serves as the primary resource for prior authorization processes, payer requirements, and workflow best practices
- Maintains advanced knowledge of pharmacy and imaging authorization guidelines across multiple payers
- Interprets complex or unclear payer requirements and provides direction to staff and providers
- Monitors buckets and prioritizes work based on urgency and patient care needs
- Assists with workload balancing to ensure timely submission and follow-up
- Monitors personal and team-aligned productivity to ensure work remains current
- Promotes adherence to turnaround time expectations and quality standards
Benefits
- A competitive benefits plan, including Medical, Dental and Vision
- Company sponsored life insurance and short and long-term disability coverage
- 403(b) retirement account with company matching
- Supplemental accident insurance available
- 9 paid holidays per year
- PTO and Personal Day accrual, starting day 1 - (We value a work-life balance!)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
