Lead Prior Authorization Specialist

Blue Ridge Health is currently seeking a Lead Prior Authorization Specialist to be part of our Medical team in Hendersonville NC.

• 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!)

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. Responsibilities include:

• 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

• High School Diploma or equivalent required
• Current North Carolina Pharmacy Technician preferred
• Strong knowledge of pharmacy terminology
• Experience working in an interdisciplinary and/or integrative health care model
• Proficiency in MS Office programs required. Familiarity with Electronic Health Records (EHR) and other databases preferred.

At Blue Ridge Health our mission is to improve Health inspire Hope and advance Healing through access to Compassionate Affordable and Quality Care. We are seeking individuals with a passion for creating an exceptional patient and client care experience to join our team! We are a nonprofit system of Federally Qualified Health Centers (FQHCs) that works closely with communities to meet the ever-changing medical and behavioral healthcare needs of individuals throughout WNC.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.

This policy applies to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absence compensation and training.