JOIN A LEADING HEALTHCARE COMPANY
At Curant Health, our vision is to personalize healthcare—driven by choice and defined by value. Our employees bring this vision to life through excellent service, personalized care, accountability, innovation, and integrity. We offer competitive pay, great benefits, and the opportunity to make a meaningful impact every day. We are seeking a Prior Authorization Specialist Supervisor in Smyrna, GA or St. Petersburg, FL to oversee clinical and operational Prior Authorization (PA) processes and ensure timely access to specialty medications.
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.
- Education: 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.