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 VisionCompany sponsored life insurance and short and long-term disability coverage403(b) retirement account with company matchingSupplemental accident insurance available9 paid holidays per yearPTO 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 practicesAssists new staff with required portal set-upProvides ongoing education related to payer updates, process changes, and documentation requirementsServes as the primary resource for prior authorization processes, payer requirements, and workflow best practicesMaintains advanced knowledge of pharmacy and imaging authorization guidelines across multiple payersInterprets complex or unclear payer requirements and provides direction to staff and providersMonitors buckets and prioritizes work based on urgency and patient care needsAssists with workload balancing to ensure timely submission and follow-upMonitors personal and team-aligned productivity to ensure work remains currentPromotes adherence to turnaround time expectations and quality standardsHigh School Diploma or equivalent, requiredCurrent North Carolina Pharmacy Technician, requiredStrong knowledge of pharmacy terminologyExperience working in an interdisciplinary and/or integrative health care modelProficiency 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.

Created: 2026-04-17