Prior Authorization Specialist Supervisor

Position Summary

The Prior Authorization Specialist Supervisor is responsible for the day-to-day oversight, coordination, and performance of the Prior Authorization Specialist team. This position supervises Prior Authorization Specialists while ensuring timely, accurate, and efficient completion of prior authorization requests, in-bound and outbound communications with providers, payers, etc. and providing support to all inquiries throughout the prior authorization process.

Responsibilities

• Maintain complete, timely, and accurate documentation of prior authorization approvals, denials, appeals, and related activities within pharmacy systems and platforms.
• Manage prior authorization requests from initiation through resolution, ensuring timely follow-up and completion.
• Gather benefit information, perform benefit investigations, submit prior authorization requests, and complete test claims as required.
• Assist providers with initiation and completion of prior authorization requests and required supporting documentation.
• Follow up with PBMs, payers, providers, and manufacturers regarding prior authorization outcomes, appeals, and coverage determinations.
• Initiate and respond to inbound and outbound communications related to prior authorization activities.
• Transfer clinical questions and clinical decision-making requests to the Prior Authorization Pharmacist.
• Communicate authorization status updates to providers, patients, and internal stakeholders.
• Conduct medical and pharmacy benefit investigations as needed.
• Assist with appeals, exception requests, patient assistance programs, and manufacturer-sponsored support programs.
• Monitor and manage work queues to ensure all cases progress appropriately and within established service levels.
• Execute and report departmental prior authorization metrics as requested by leadership.
• Serve as a department subject matter expert and resource for team members.

Qualifications

• Minimum one (1) year in the PA Specialist Role at Curant Health with a satisfactory performance rating of meets or exceeds expectations.
• At least three (3) years of experience in a retail pharmacy environment or related field preferred.
• Two (2) years prior experience with performing Prior Authorizations within the pharmacy, pharmacy benefit insurance or PBM field preferred.
• 340B knowledge is strongly preferred.
• Must be proficient in creating and editing documents with Microsoft Word, Excel, and PowerPoint.
• Requires at least three (3) years of experience in the field or in a related area.
• Must be a registered Pharmacy Technician in the state which work will be conducted.
• PTCB certification a plus but not required.