PAHub & Prior Authorization Specialist

RXinsider LTD.; New Jersey; Hybrid; USD 85,000 - 115,000; Full time

Job summary

Agadia Health Systems, Inc. seeks a PAHub & Prior Authorization Specialist to guide customers through implementation, optimization, and ongoing support, leveraging deep PAHub knowledge to improve adoption and outcomes.

Responsibilities include conducting product demonstrations, delivering role-based training, and collaborating across product, training, and operations teams to ensure compliance and customer success.

Qualifications

• 5+ years in healthcare operations, prior authorization, utilization management, or related fields.
• Hands-on experience with PAHub or similar prior authorization platforms.
• Strong understanding of PA workflows, regulatory requirements, and operations.
• Experience working directly with customers in a consultative or client-facing capacity.
• Excellent presentation, facilitation, and communication skills.
• Ability to explain complex technical concepts to varied audiences.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced environment with minimal supervision.
• Maintain confidentiality in accordance with HIPAA guidelines.
• Highly self-motivated with integrity.

Responsibilities

• Serve as PAHub SME for customers across implementation, optimization, training, and support.
• Participate in customer calls, workshops, reviews, and operational meetings.
• Develop relationships with stakeholders by understanding workflows and goals.
• Advise on best practices and PAHub capabilities.
• Identify opportunities to improve efficiency, turnaround times, and satisfaction.
• Monitor adoption and recommend process improvements.

Skills

Healthcare ops

PAHub experience

Prior authorization

Customer-facing

Presentation skills

Technical communication

Analytical skills

Multi-tasking

HIPAA compliance

Self-motivated

Job description

Reports To: Vice President, Customer Experience

Location: Remote/Hybrid with 10% travel nationwide

The PAHub & Prior Authorization Specialist serves as a trusted consultant to customers and internal teams, helping maximize the value, effectiveness, and adoption of PAHub. This role bridges the gap between product functionality, customer operations, implementation, account management, training, and support.

The ideal candidate possesses deep knowledge of prior authorization workflows and PAHub capabilities and can effectively communicate with both operational users and executive stakeholders. The Specialist will participate in customer meetings, support internal teams, provide product demonstrations, identify optimization opportunities, and assist in the development of customer-facing documentation and training materials.

This role plays a critical part in ensuring customers achieve their desired business outcomes while helping internal teams deliver consistent, high-quality customer experience.

Key Responsibilities

Customer Engagement & Advisory

• Serve as a PAHub subject matter expert for customers throughout implementation, optimization, training, and ongoing support activities.
• Participate in customer calls, workshops, business reviews, and operational meetings.
• Develop trusted relationships with customer stakeholders by understanding their workflows, goals, challenges, and business requirements.
• Advise customers on industry best practices and optimal use of PAHub functionality.
• Identify opportunities to improve customer efficiency, automation, turnaround times, and overall satisfaction.
• Proactively monitor customer adoption and recommend process improvements and workflow enhancements.

Product Demonstrations & Training

• Conduct PAHub demonstrations for prospective and existing customers.
• Showcase new features, product enhancements, and best practices.
• Deliver customer training sessions tailored to different user roles and operational functions.
• Assist customers in understanding how PAHub functionality supports their business and regulatory requirements.
• Support onboarding activities for new customers and new customer team members.

Internal Team Support

• Act as a resource for Account Management, Customer Success, Support, Implementation, Product, Training, and Operations teams.
• Participate in internal customer strategy discussions and planning meetings.
• Provide guidance on customer workflows, business requirements, and PAHub capabilities.
• Help internal teams evaluate customer enhancement requests and identify potential solutions.
• Share customer feedback, trends, and opportunities with Product Management and leadership teams.

Product Adoption & Optimization

• Assess customer utilization of PAHub and identify opportunities for improvement.
• Recommend workflow changes, configuration updates, and training opportunities to increase efficiency.
• Help customers leverage existing functionality before pursuing custom development.
• Support feature adoption initiatives and change management efforts.
• Track customer challenges and coordinate with internal teams to ensure timely resolution.

Documentation & Knowledge Management

• Partner with the Documentation and Training teams to create, review, and improve customer-facing materials.
• Validate user guides, training materials, release communications, knowledge articles, and implementation documentation for accuracy and usability.
• Assist in developing best practice guides, workflow examples, and process documentation.
• Review customer communications to ensure clear and consistent messaging.

Voice of the Customer

• Gather customer feedback and communicate key themes to Product, Engineering, and Leadership teams.
• Advocate for customer needs while balancing product strategy and operational considerations.
• Assist in prioritizing customer requests by providing business and workflow context.
• Identify recurring customer questions and contribute to continuous improvements in training and documentation.

Required Qualifications

• 5+ years of experience in healthcare operations, prior authorization, utilization management, PBM, health plan operations, specialty pharmacy, or healthcare technology.
• Hands-on experience with PAHub or a similar prior authorization platform.
• Strong understanding of prior authorization workflows, operations, and regulatory requirements.
• Experience working directly with customers in a consultative or client-facing capacity.
• Excellent presentation, facilitation, and communication skills.
• Ability to explain complex technical concepts to both technical and non-technical audiences.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced, demanding environment with minimal supervision.
• Maintain the strictest confidentiality in compliance with HIPAA guidelines.
• Highly self-motivated, professional, take-charge attitude with humility and integrity.

Preferred Qualifications

• Experience supporting SaaS healthcare applications.
• Experience in training, customer success, account management, implementation, and/or consulting.
• Knowledge of CMS, Medicaid, Medicare, and commercial utilization management processes.
• Pharmacy Technician certification, pharmacist, or related healthcare credentials.
• Experience creating documentation, training content, or knowledge management materials.

The PAHub & PA Specialist Will Be Successful When

• Customers are effectively utilizing PAHub functionality and adopting new features.
• Customer satisfaction and engagement levels improve.
• Internal teams have access to timely, accurate product expertise.
• Product demonstrations and training sessions are highly effective and well-received.
• Documentation and customer-facing materials are accurate, useful, and easy to understand.
• Customer feedback is translated into actionable improvements that enhance the overall customer experience.

This position offers a unique opportunity to influence customer success, product adoption, and the overall customer experience strategy while serving as a recognized PAHub expert across the organization.

Pay Range: Actual compensation will be determined based on the candidate's experience, qualifications, and work location. Candidates in different geographic markets may be offered compensation that reflects local market conditions.

Agadia Health Systems, Inc. is a leading healthcare management technology company addressing the evolving needs of the managed care market with a suite of utilization management solutions in electronic prior authorization, MTM, Part D star ratings & adherence, grievances, and formulary benefit design. Used by the nation’s largest health plans and PBMs, Agadia’s advanced technology solutions help drive operational efficiency, appropriate utilization, compliance, and profitability

Agadia is an Equal Opportunity Employer