Senior Central Prior Authorization Analyst

Adventist Health•Roseville, CA

6d•$31 - $40•Onsite

About The Position

Serves as a subject matter expert and strategic partner in optimizing infusion site-of-care decisions, pharmacy access, and revenue integrity. This role operates with a high degree of autonomy and is responsible not only for executing complex workflows, but also for leading process improvement initiatives, influencing cross-functional stakeholders, and driving measurable financial and operational outcomes. In coordination with financial clearance, pharmacy, and clinical teams, this role evaluates and determines the most appropriate infusion site of care based on clinical appropriateness, payer policy, and financial impact. The Senior Analyst leverages advanced analytics, deep payer knowledge, and system-wide insights to optimize patient access, minimize denials, and maximize reimbursement across the continuum of care.

Requirements

Six years' of progressive experience in infusion, specialty pharmacy, revenue cycle, or related healthcare operations: Required
Experience in Epic or similar electronic medical records (EMR) platforms: Preferred
Knowledge of healthcare insurance, prior authorization and/or coding: Preferred
State Pharmacy Technician license (CA, OR, &/or HI): Preferred
Pharmaceutical Technician Board certification: Preferred
Advanced certification (e.g., CHRI, CRCR, or 340B ACE): Preferred
Pharmaceutical Technician Board certification: Preferred

Nice To Haves

High School Education/GED or equivalent: Preferred
Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred

Responsibilities

Serves as the lead subject matter expert for infusion site-of-care strategy, payer requirements, and pharmacy benefit optimization.
Independently evaluate complex patient cases to determine optimal infusion site of care, balancing clinical appropriateness, payer constraints, and financial impact.
Lead coordination with central financial clearance, pharmacy operations, and clinical teams to ensure seamless referral routing across home infusion, ambulatory infusion, and alternate care sites.
Oversee and perform advanced benefit investigation, prior authorization strategy, and denials resolution, including escalation of high-risk or high-dollar cases.
Identify trends in denials, payer behavior, and workflow inefficiencies; develop and implement data-driven process improvements.
Act as a strategic liaison between pharmacy, revenue cycle, and clinical operations to enhance patient access and optimize reimbursement.
Provide guidance, training, and mentorship to analysts and technicians; serve as an escalation point for complex issues.
Drive standardization of workflows, documentation practices, and referral processes across the health system.
Promote and articulate the value of the infusion hub model and site-of-care strategy to internal and external stakeholders.
Build and maintain strong relationships with physicians, clinic leadership, pharmacy teams, and payers.
Act as a financial advocate for patients, leveraging manufacturer assistance programs, foundations, and alternative funding sources.
Participate in or lead cross-functional projects, pilots, and system implementations related to pharmacy services and revenue optimization.
Ensure compliance with regulatory requirements (e.g., CMS, payer policies, 340B considerations where applicable).
Provide coverage support while maintaining oversight of broader program performance and service delivery.
Assesses, develops, and recommends the best method of providing ambulatory infusion pharmacy services to support patients based on health system guidance.
Develops and maintains close relationships with clinic staff, physician, pharmacy and other hospital contacts.
Independently, and working hand in hand with client authorization resources, facilitates benefits verification and prior authorizations services for infusion site of care patients.
Performs other job-related duties as assigned.