Supervisor, Medical Prior Authorization

House Rx•Pittsburgh, PA

About The Position

The Medication Authorization Supervisor is responsible for building the playbook and leading the daily operations of the Medical Benefit Authorization team. This leader ensures patients receive timely access to therapy by driving operational excellence across benefit investigations, medical prior authorizations, payer documentation, appeals, and authorization renewals. This role balances people leadership with operational ownership, ensuring quality, productivity, turnaround time, and customer satisfaction while continuously improving workflows across multiple specialties.

Requirements

5+ years of experience in medical benefit prior authorizations or specialty reimbursement.
2+ years of people leadership or supervisory experience.
Experience supporting provider-administered specialty medications.
Strong knowledge of commercial, Medicare, and Medicaid medical benefit authorization processes.
Experience with infusion therapies, biologics, oncology, rheumatology, gastroenterology, neurology, or dermatology medications.
Strong understanding of payer medical policies and clinical documentation requirements.
Exceptional organizational and communication skills.
Ability to manage multiple priorities in a fast-paced environment.

Nice To Haves

Experience working within specialty pharmacy, physician dispensing, infusion centers, or specialty physician practices.
Experience with appeals, medical necessity documentation, and peer-to-peer support.
Knowledge of EMRs such as Epic, eClinicalWorks, or OncoEMR.
Experience with specialty reimbursement platforms and authorization management systems.
Bachelor's degree or equivalent healthcare experience

Responsibilities

Lead, coach, and develop a team of Medication Authorization Specialists.
Monitor daily workload and staffing to meet service level expectations.
Conduct quality reviews, provide coaching, and implement performance improvement plans when necessary.
Train new employees and establish ongoing competency programs.
Foster a culture focused on accountability, collaboration, and continuous improvement.
Oversee end-to-end medical authorization workflows for provider-administered specialty medications.
Ensure timely submission of medical prior authorizations, predeterminations, and supporting clinical documentation.
Monitor authorization turnaround times and proactively resolve barriers impacting patient care.
Develop and maintain standard operating procedures.
Partner with Product and Operations teams to improve workflows and automate manual processes.
Identify trends impacting payer approvals and implement process improvements.
Serve as the escalation point for complex medical authorization cases.
Maintain expertise in commercial, Medicare Advantage, Medicaid, and other payer medical policies.
Review payer guidelines, clinical criteria, and authorization requirements.
Support appeals and peer-to-peer preparation when appropriate.
Collaborate with providers and clinical staff to obtain necessary documentation.
Partner closely with Customer Success, Operations, Pharmacy, Finance, and Implementation teams.
Communicate payer changes that impact customer workflows.
Support implementation of new clinics and specialty service lines.
Participate in customer escalations as the medical authorization subject matter expert.
Monitor KPIs including: Authorization turnaround time, Approval rate, First-pass submission quality, Productivity, Appeal success rate, Customer SLA adherence.
Utilize reporting to identify trends and implement corrective actions.