House Rx
Supervisor, Medical Prior Authorization
Pittsburgh, PA
Sponsorship not specifiedDetected 12 days ago
Performance ManagementCustomer SuccessEpicPharmacy PracticeLeadershipCommunicationCollaborationMentoring
About the role
- 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.
Responsibilities
- Lead, coach, and develop a team of Medication Authorization Specialists.
- Conduct quality reviews, provide coaching, and implement performance improvement plans when necessary.
- 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.
- 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.
- Support implementation of new clinics and specialty service lines.
Requirements
- 2+ years of people leadership or supervisory experience.
- Experience supporting provider-administered specialty medications.
- Experience with infusion therapies, biologics, oncology, rheumatology, gastroenterology, neurology, or dermatology medications.
- Experience working within specialty pharmacy, physician dispensing, infusion centers, or specialty physician practices.
- Knowledge of EMRs such as Epic, eClinicalWorks, or OncoEMR.
- Required
- 5+ years of experience in medical benefit prior authorizations or specialty reimbursement.
- Strong knowledge of commercial, Medicare, and Medicaid medical benefit authorization processes.
- 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.
- Preferred
- Experience with appeals, medical necessity documentation, and peer-to-peer support.
- Experience with specialty reimbursement platforms and authorization management systems.
Compensation
- Competitive salary and equity stake
Benefits
- Flexible paid time off
- Generous parental leave
- Comprehensive healthcare, vision and dental benefits
- Competitive salary and equity stake
- Oversee end-to-end medical authorization workflows for provider-administered specialty medications.
- Ensure timely submission of medical prior authorizations, predeterminations, and supporting clinical documentation.
- Clinical & Reimbursement Expertise
- Serve as the escalation point for complex medical authorization cases.
- Maintain expertise in commercial, Medicare Advantage, Medicaid, and other payer medical policies.
- Participate in customer escalations as the medical authorization subject matter expert.
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