PAHub & Prior Authorization Specialist
RXinsider
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 #J-18808-Ljbffr
- 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...SuggestedRemote job
$101.18k - $120.46k
...Senior Shared Services Specialist Argo Group is an underwriter of specialty insurance products... ...direction and within broad limits and authority, partner with adjuster, auto/property... ...for this or any other position without prior authorization from Human Resources will...SuggestedWork experience placementLocal area- ...About the Role We’re hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice. Prior authorization is one of the largest operational bottlenecks for agencies. Our platform automatically verifies...Suggested
$80 per hour
...OpportunityWe are sharing a specialised part-time consulting opportunity for United States-based healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization workflows, documentation review,...SuggestedHourly payPart timeFor contractorsWork at officeRemote workFlexible hours- ...Overview Large Cardiology Practice located in Kew Gardens, Queens, is seeking a Prior Authorization Specialist that meets the following requirements: Benefits Competitive salary Health insurance Opportunity for advancement Paid time off Profit sharing Health benefits...Suggested
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- ...and specialty providers. Job Overview: The Intake Specialist is responsible for managing incoming referrals for specialty... ...Ensure all required elements are obtained prior to benefits investigation and authorization Conduct welcome calls to patients, explaining services...Work at officeRemote work
- ...Representative responsible for managing Care Coordination services and Health Information Management tasks. The role includes prior authorizations, electronic filing, and ensuring compliance with protocols. Ideal candidates will have a High School Diploma, experience in...Remote jobWork from home
$75.35k - $98.89k
Hi, we're Oscar. We're hiring a Senior Specialist, Process Improvement to join our Authorization Services Process Improvement team. Oscar is the first health insurance... ...to get agreement on decision Bonus points: Prior work experience in Prior Authorizations or...Full timeTemporary workWork experience placementWork at officeFlexible hoursShift work- WellDyne is seeking a Prior Authorization Tech II to initiate clinical PA requests by phone or email, create and fax cases, and document all activity with accuracy. You will also complete PA requests via telephone with prescriber staff and work closely with pharmacies,...
- OOS Management Corp. is looking for a meticulous Authorizations Specialist in New York City. You will be responsible for submitting and tracking prior authorization requests to insurance companies, helping our therapists and BCBAs serve families effectively. The ideal candidate...
- MedImpact Healthcare Systems, Inc. is hiring for a Prior Authorization Operations role to process PA requests, validate information, and ensure timely, accurate determinations following clinical guidelines and client requirements. The position emphasizes collaboration with...
$61.29k - $68.86k
...join our team as an Offshore Operational Specialist. In this role, the successful candidate... ...Responsibilities Financial Clearance, Authorization, Eligibility Verification & Patient... ...Financial Clearance activities, including prior authorization, eligibility verification...Work at officeRemote work- ...Services, PLLC are on the hunt for a meticulous and proactive Authorizations Specialist to keep our clinical services moving without interruption.... ...you secure matters Responsibilities Submit and track prior authorization requests to insurance companies daily Communicate...Hourly pay
- Judi Health is seeking a PA Systems Specialist to maintain and validate prior authorization criteria, decision trees, and templates within the PA system. You will translate clinical requirements into system logic, collaborate with pharmacists and cross-functional teams,...
$55k - $60k
...package, and a competitive benefits program. Job Summary The Authorizations Specialist ensures timely payer approvals by managing authorizations,... ...various health plans. This role reports to the Manager, Prior Authorization within the Reimbursement Operations Department...Full timeContract workRemote work$25 - $27 per hour
Harlem Cardiology on Madison Avenue in New York City seeks a skilled medical biller and insurance authorization specialist to obtain prior authorizations for procedures. Join a dedicated cardiology team delivering cardiovascular care to East Harlem residents; compensation...Hourly payFull time- Wellstar Health System is hiring a PAS III for Pre-Service Operations to secure authorizations and verify benefits, working with physicians and care teams. You will escalate issues, maintain accurate records, and support pre-registration activities in a fast-paced hospital...
- ...orthopedic clinics to help optimize operations and improve financial performance. Prior authorizations are a critical component of that success. We are seeking a Prior Authorization Specialist (Contract) to support high-volume authorizations for both procedures and...Contract workRemote work
- ...Solutions and currently, I am looking for a EDI Integration Specialist (Not Developer) for our client . Please see the job... ...healthcare processes including claims, eligibility, payments, and prior authorizations. ~ Solid understanding of XML, JSON, SQL, REST, and...Contract workRemote work
- ...patients registered and covered, securing authorizations, moving claims through to payment,... ...interpretation, intake, and referral management Prior Authorizations & Utilization Support:... ...Medical Office Manager Revenue Cycle Specialist / RCM Analyst Medical Billing...Work at office
- Inspire Medical Systems is recruiting a Prior Authorization Specialist to implement the US-based Prior Authorization Program and collaborate with Territory Managers and the prior authorization team to resolve coding and coverage questions efficiently. The role requires...Remote job
- NeueHealth is seeking a Utilization Management Prior Authorization Nurse to ensure appropriate benefit coverage and evidence-based care for assigned populations. You will collaborate with Medical Directors and clinicians to review authorizations for treatments, medications...
- A U.S.-based healthcare service is seeking a Pre-Authorization & Referral Coordinator to manage insurance verifications, prior authorizations, and referrals for a fast-paced medical office. The ideal candidate should have over 2 years of experience in a U.S. medical setting...Remote jobFull timeFor contractorsWork at office
$20 - $28.8 per hour
...the direction of the Supervisor, Referrals, the Referrals Specialist serves as a primary interface between patients, providers,... ...Epic and insurance portals. Verify eligibility and obtain prior authorizations/pre-certifications as needed. Route/fax medical documentation...Remote jobFull timeWork at office$16.48 - $20.61 per hour
...members in scheduling necessary medical visits. •Enter prior approvals in the authorization System (CareConnect). •Use CareConnect system to enter... ...the Team Lead or the management team. The Enrollment Specialist is responsible for processing new enrollment authotizations...Permanent employmentFull timeTemporary workMonday to Friday$145k - $180k
...Make:We are looking for an experienced PolyPath Market Risk Specialist with strong technical and business knowledge to support pricing... ...experience, training, military service, or education.Work Authorization & Sponsorship:Applicants must be legally authorized to work in...Hourly payFull timeContract workWork experience placementShift work$90k - $140k
...London, Tokyo and Singapore, which manages Fixed Income portfolios for a broad range of clients. The RoleThe Fixed Income Portfolio Specialist will be responsible for servicing existing clients and driving commercialization of the institutional Global Multi-sector...Temporary workWork at officeWorldwide- ...Job Description Job Description LaSante Health Center is seeking a Referrals and Prior Authorization Specialist to join our team. The ideal candidate will help ensure patients have seamless access to medications, diagnostic imaging, and specialty care by managing...
$17.46 per hour
...an agency program. ESSENTIAL DUTIES AND RESPONSIBILITIES The duties and responsibilities of the On-Call Residence Program Specialist will include, but are not limited to the following: Provide support as a Residential Program Specialist in designated program,...
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