Prior Authorization Specialist: Pharma & Imaging

Blue Ridge Health; Hendersonville (NC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life Insurance

401(k) with company match

Disability coverage

Paid holidays

PTO & Personal Day

Flexible schedules

Job summary

Blue Ridge Health in Hendersonville, NC is seeking a Prior Authorization Specialist to join our Medical team. You will collaborate with patients, staff, and payers to obtain timely prior authorizations for pharmaceutical and imaging needs.

The role requires a High School Diploma or equivalent and a current North Carolina Pharmacy Technician license, with strong knowledge of pharmacy terminology and familiarity with EHRs. MS Office skills are essential; Spanish is a plus.

Qualifications

• High School Diploma or equivalent required.
• Current North Carolina Pharmacy Technician license required.
• Strong knowledge of pharmacy terminology.
• Experience in an interdisciplinary health care model.
• Proficiency in MS Office; EHR familiarity preferred.

Responsibilities

• Applies clinical and pharmaceutical criteria for processing prior authorization requests for pharmacy needs.
• Reviews Medicaid prescription rejections in NCTracks.
• Applies criteria for imaging prior authorizations.
• Processes appeals and redeterminations as needed.
• Assists in provider training on prior authorization processes.
• Communicates with appropriate parties for timely completion of prior authorizations.

Education

High School Diploma or equivalent

Current North Carolina Pharmacy Technician license

Strong knowledge of pharmacy terminology

Experience in interdisciplinary healthcare model

Proficiency in MS Office

Familiarity with EHRs

Spanish (preferred)

Tools

MS Office

EHR systems

Job description

Blue Ridge Health in Hendersonville, NC is seeking a Prior Authorization Specialist to join our Medical team. You will collaborate with patients, staff, and payers to obtain timely prior authorizations for pharmaceutical and imaging needs.

The role requires a High School Diploma or equivalent and a current North Carolina Pharmacy Technician license, with strong knowledge of pharmacy terminology and familiarity with EHRs. MS Office skills are essential; Spanish is a plus.