Prior Authorization Lead

Location: AON Pharmacy

Pay Range:

Position Summary

The Prior Authorization Technician Team Lead is responsible for coordinating Prior Authorization team activities and workflows, including scheduling coordination and the approval and delegation of timecard-related processes. The Team Lead serves as the department's subject matter expert, assisting leadership with daily operations, productivity monitoring, process improvements, and ensuring high-quality patient service. The Team Lead is also responsible for submitting prior authorizations and appeals on behalf of AON physicians.

The Prior Authorization Technician Team Lead will ensure that all required supporting documentation - including physician notes, laboratory results, pathology reports, clinical literature, and other relevant records - is submitted in accordance with insurance carrier guidelines to facilitate coverage determinations for medically necessary medications as prescribed by the ordering physician.

This role requires a working knowledge of all aspects of the position, applicable regulations, and organizational and departmental policies and procedures. The Team Lead performs all duties in compliance with regulatory requirements and organizational standards and may be assigned additional duties and special projects as needed.

Key Performance Areas

KPA 1 – Prior Authorization Management

• Submit prior authorization requests on behalf of AON physicians for specialty medications.

• Monitor the status of prior authorization requests and follow up with insurance carriers when responses are delayed.

• Resolve prior authorization issues in a timely manner.

• Communicate approval or denial outcomes to physicians, clinic staff, and patients.

• Maintain knowledge of payer authorization requirements and submission processes.

KPA 2 – Appeals Management

• Verify medical necessity with providers following prior authorization denials.

• Prepare and submit appeals, including supporting clinical documentation, letters of medical necessity, and NCCN guidelines as appropriate.

• Collaborate with physicians and nursing staff to support complex and off-label medication requests.

• Communicate appeal decisions to physicians, clinic staff, and patients.

• Refer patients to the Financial Assistance team when medications remain denied after appeal.

KPA 3 – Claims Resolution & Benefit Support

• Collaborate with insurance-mandated specialty pharmacies to resolve authorization-related issues.

• Submit Cost Exceeds Overrides, Tier Exceptions, Quantity Limit Overrides, and other payer-specific requests as required.

• Interpret insurance claim responses to determine patient financial responsibility and coordinate referrals to internal support teams.

• Maintain working knowledge of electronic, paper, and telephone authorization submission processes.

KPA 4 – Operational Leadership & Workflow Coordination

• Coordinate daily workflow and prioritize team assignments to meet service level expectations.

• Monitor work queues and identify aging requests requiring immediate attention.

• Assist the Pharmacy Operations Supervisor with workload balancing and operational planning.

• Serve as the first point of contact for complex benefit verification questions and escalations.

• Communicate daily priorities, workflow changes, and operational updates to the team.

• Identify workflow inefficiencies and recommend process improvements.

• Lead by example while maintaining individual productivity expectations.

• Collaborate with the Pharmacy Operations Supervisor on departmental initiatives and projects.

KPA 5 – Team Development, Training & Quality

• Assist with onboarding, training, and coaching new and existing team members.

• Develop and maintain training materials, workflow documentation, and individualized training plans.

• Coordinate team schedules, paid time off, training, and call center coverage to ensure appropriate staffing.

• Support quality assurance initiatives through audits, coaching, and performance feedback.

• Promote standardized workflows and adherence to departmental procedures.

• Foster a collaborative, patient-centered culture through mentorship and leadership.

KPA 6 – Customer Service & Interdepartmental Communication

• Provide professional, timely, and accurate communication with patients, providers, clinics, specialty pharmacies, and internal departments.

• Serve as a liaison between AON and specialty pharmacies to ensure timely follow-up through phone, email, and electronic portals.

• Demonstrate active listening and respond to patient and provider inquiries with accurate information and solutions.

• Review team email communications to ensure timely, professional responses.

• Promote collaboration across departments to improve patient care and operational efficiency.

• Model exceptional customer service and reinforce patient-centered communication standards.

KPA 7 – Compliance & Regulatory Standards

• Ensure compliance with all federal, state, and local regulations, pharmacy SOPs, accreditation standards, and AON policies.

• Complete all required compliance education and departmental training by established deadlines.

• Maintain continuing education requirements necessary for Pharmacy Technician licensure.

• Protect the confidentiality of patient and employee information in accordance with HIPAA.

• Support proper handling, storage, retention, and destruction of Protected Health Information (PHI).

• Perform other duties and special projects as assigned.

Position Qualifications

Education

• High school diploma, GED, or equivalent required.

Minimum Relevant Experience

• Minimum two (2) years of experience as a Pharmacy Technician in a specialty, retail, mail order, or hospital pharmacy required.

• Prior Authorization experience preferred.

• Experience working in a fast-paced, multi-site healthcare environment preferred.

• Experience supporting operational workflows, process improvements, and cross-functional collaboration preferred.

Certifications/Licenses

• Active, unrestricted Pharmacy Technician permit in the state of residence required.

• Willingness to obtain a Florida Pharmacy Technician permit, if applicable.

Skills

• Strong critical thinking, problem-solving, decision-making, organizational, and time management skills with attention to detail.

• Excellent verbal and written communication, interpersonal, conflict resolution, and customer service skills.

• Ability to build collaborative relationships, foster teamwork, and maintain professionalism while handling confidential and sensitive information.

• Self-motivated with the ability to manage competing priorities, work independently, and adapt in a fast-paced, multi-site environment.

• Proficient in Microsoft Word, Excel, PowerPoint, and Outlook, with the ability to quickly learn pharmacy systems and payer platforms.

Travel: 0-25%

Expectations for All Employees

This position description reflects the general duties and responsibilities necessary to perform the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. The responsibilities listed may be subject to change at any time and individuals may be asked to perform duties outside of their regular responsibilities to support the ongoing business operation needs.

Americans with Disabilities Act (ADA) Compliance

The essential functions described herein are intended to define the fundamental duties of the position and serve as the minimum requirements for performance. They do not represent an exhaustive list of all job duties that may be required. AON complies with the Americans with Disabilities Act (ADA) and applicable state and local laws. The Company will engage in an interactive process to evaluate and, where appropriate, provide reasonable accommodations to qualified individuals with disabilities, provided such accommodations do not impose an undue hardship on the business.

Physical Requirements

• Standing for long periods

• Fine motor control

• Lifting up to 25 lbs.

• Visual accuracy

Cognitive Requirements

• Attention to detail

• Following specific protocols

• Interpreting test results

Environmental Requirements

• Exposure to chemicals, biological samples, lab equipment, and noise.

Accommodation Notes

• Anti-fatigue mats

• Ventilation controls

• PPE alternatives

• Visual aid tools

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