Blue Ridge Community Health Services·Hendersonville, North Carolina
The specialist facilitates the exchange of information to obtain timely prior authorizations for pharmaceutical and imaging needs. Responsibilities include processing requests, managing appeals, and coordinating with patients, providers, and third-party payers.
Blue Ridge Health is currently seeking a Prior Authorization Specialist to be part of our Medical team in Hendersonville, NC.
The Prior Authorization Specialist collaborates with patients, internal staff, other medical center representatives, and third-party payers to facilitate the smooth exchange of information related to obtaining timely prior authorizations for pharmaceutical and imaging patient needs. Responsibilities include:
Applies clinical and pharmaceutical criteria for processing prior authorization requests in a timely manner for pharmacy needs. Reviews notifications of patient prescription rejections via covermymeds.com, faxed document scanned directly to the desktop, or patient notification
Reviews received Medicaid prescription rejections in NCTracks
Applies clinical and pharmaceutical criteria for processing prior authorization requests in a timely manner for imaging needs.
Processes appeals and redeterminations as needed
Assists in provider training or updates on efficiencies related to the prescription or imaging process prior authorization process.
Communicates with appropriate parties in a timely and effective manner for completion of prior authorizations.
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.
Candidates must have a high school diploma and a current North Carolina Pharmacy Technician certification. Proficiency in MS Office is required, while experience with EHR and Spanish language skills are preferred.
Market context
In North Carolina, administration roles tied to food and nutrition are often competitive because employers typically want a baccalaureate degree, current Registered Dietitian status, and LDN licensure or eligibility. Career advancement and clinical ladder programs can make these positions attractive, especially in settings where coordination, compliance, and patient support matter. This platform AI-summarizes requirements and benefits from the original job description, helping you review fit faster; confirm your LDN eligibility before applying.
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