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Prior Authorization Specialist, Lead

Company Overview
Founded in 2015, PHIL is a San Francisco-based, Series D health-tech startup that is building a platform that interfaces between doctors, pharmacies, and patients to streamline the process of patients receiving prescriptions. This is a complex, archaic industry, and we've set out to change that.
PHIL’s B2B2C platform provides an end-to-end prescription management and delivery service. Our robust platform connects patients, prescribers, pharmacies, and manufacturers, enabling easy and affordable access to medicine. Through its digital stakeholder experiences, patient access services, market access solutions, and distribution models, pharma manufacturers can deliver affordable and timely therapy access to patients, resulting in more patients staying on their treatment plans longer. Consequently, pharma manufacturers are enabled for more innovation.
The team at PHIL is a group of like-minded individuals from varying backgrounds, passionate about creating a new and innovative healthcare platform that is focused on patient experience and overall human wellbeing. Ready to join our team of mission-driven, analytical, and passionate people? Keep reading!

Position Overview
PHIL is seeking a talented and experienced Prior Authorization Lead to oversee the day-to-day operations of the Prior Authorization team. This role involves coaching and guiding associates to meet team quality and productivity goals, ensuring that all activities align with company objectives. Reporting to the Prior Authorization Manager, you will play a key role in supporting the success of the Prior Authorization team and ensuring smooth workflow and client satisfaction.

Responsibilities

  • Goal Formulation: Assist in formulating goals for individuals and the team, ensuring alignment with organizational objectives and metrics.

  • Hiring & Onboarding: Support the hiring process and assist in onboarding new team members to ensure they are equipped for success.

  • Staff Guidance & Support: Answer questions from staff, provide guidance, and offer constructive feedback to ensure ongoing development and performance.

  • Escalation Management: Triage and respond to client or patient escalations, providing timely and effective resolutions.

  • Process Improvement: Identify inefficient procedures, investigate and suggest improvements to enhance agent productivity or performance.

  • Policy Adherence: Ensure team members adhere to attendance policies and maintain adequate daily coverage to meet performance metrics.

  • Performance Evaluation: Regularly evaluate team performance using key metrics and provide actionable feedback to drive continuous improvement.

  • Workflow Management: Assess queues, implement daily workflow plans, and report on progress to the Manager of Operations.

Qualifications

  • Must be available to assist with training and onboarding in the Arizona office as needed

  • Solid knowledge of insurance authorization and appeals processes, PHILRx program rules, operations dashboard, Zendesk, and CoverMyMeds

  • Professional leadership experience preferred, or a demonstrated ability to lead projects and guide the work of others

  • Experience reading metric reports and maintaining spreadsheets in Excel / Google Docs

  • Strong written and verbal communication skills, with the ability to clearly explain complex concepts to team members and stakeholders

  • Strong problem-solving skills, with the ability to identify issues and implement effective solutions

Benefits

  • Ground floor opportunity with one of the fastest-growing startups in health-tech

  • Fully remote working environment with occasional travel to the Arizona office

  • Competitive compensation (commensurate with experience)

  • Full benefits (medical, dental, vision)

  • 401(k) contribution opportunity

PHIL Inc. is an equal-opportunity employer.

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Average salary estimate

$75000 / YEARLY (est.)
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$60000K
$90000K

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What You Should Know About Prior Authorization Specialist, Lead, Phil

At PHIL, we're transforming healthcare into something that prioritizes the patient experience, and we’re on the lookout for a Prior Authorization Specialist, Lead to be part of our mission-driven team in Scottsdale. Joining us means you’ll play a crucial role in overseeing our Prior Authorization operations, guiding a dedicated team as we work to streamline prescription management to better serve patients, pharmacies, and providers alike. Your day-to-day will involve coaching associates to achieve their goals while ensuring we meet the high standards we set for ourselves. You’ll be at the heart of our Prior Authorization process, tackling client escalation issues, identifying inefficiencies, and collaborating with the team to refine our approach. We’re a tight-knit group of innovative minds from diverse backgrounds, all passionate about making a positive impact. Your leadership will help ensure that every team member shines, receiving the guidance they need as we navigate the complex landscape of healthcare. With us, you'll have the opportunity to assist with hiring and onboarding, evaluate team performance, and create a solid workflow plan for daily operations. Our ideal candidate comes with a solid grasp of insurance authorizations and the PHILRx program, along with strong communication and problem-solving skills. If you're ready to lead with confidence and innovation, while enjoying a fully remote working environment that occasionally welcomes you to our Arizona office, we’d love to see how you can contribute to the PHIL vision.

Frequently Asked Questions (FAQs) for Prior Authorization Specialist, Lead Role at Phil
What are the daily responsibilities of a Prior Authorization Specialist, Lead at PHIL?

As a Prior Authorization Specialist, Lead at PHIL, your daily responsibilities will include managing the operations of the Prior Authorization team, coaching associates, addressing client escalations, and ensuring adherence to company policies. You’ll also assist in formulating individual and team goals, onboarding new staff, and identifying process improvements to enhance efficiency.

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What qualifications are necessary for the Prior Authorization Specialist, Lead position at PHIL?

To be successful in the Prior Authorization Specialist, Lead position at PHIL, you'll need a strong understanding of insurance authorization processes, excellent communication skills, and previous leadership experience is preferred. Familiarity with tools like Zendesk and a knack for analytics through metric reporting and spreadsheets is also important.

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How does PHIL support the ongoing development of a Prior Authorization Specialist, Lead?

PHIL actively supports the ongoing development of a Prior Authorization Specialist, Lead by fostering a culture of continuous improvement. You'll receive constructive feedback regularly and have access to training opportunities. The structure of the team encourages collaboration, allowing you to share best practices and learn from each other.

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What is the work environment like for a Prior Authorization Specialist, Lead at PHIL?

Working as a Prior Authorization Specialist, Lead at PHIL means being part of an innovative and driven health-tech startup. Our work environment is fully remote with occasional travel to the Arizona office, allowing for flexibility in your schedule while being surrounded by a supportive team dedicated to improving healthcare access.

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What benefits can a Prior Authorization Specialist, Lead expect at PHIL?

As a Prior Authorization Specialist, Lead at PHIL, you can expect competitive compensation, comprehensive benefits including medical, dental, and vision, as well as opportunities for 401(k) contributions. You'll be part of a ground-floor opportunity with one of the fastest-growing companies in health-tech, emphasizing personal and professional growth.

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Common Interview Questions for Prior Authorization Specialist, Lead
What strategies do you use to ensure quality and productivity in a Prior Authorization team?

To ensure quality and productivity in a Prior Authorization team, I focus on setting clear performance goals, providing ongoing training, and fostering an open line of communication where team members can share challenges and solutions. Regular evaluations and constructive feedback are key to our success.

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How do you handle escalations from clients or patients?

Handling escalations requires a calm and systematic approach. I first listen actively to understand the issue, then I assess the situation, consult any relevant documentation, and formulate a solution. Keeping the client informed throughout the process is also crucial for maintaining trust.

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Can you describe your experience with the insurance authorization process?

I have extensive experience with the insurance authorization process, which includes understanding requirements for patient eligibility, navigating various insurance policies, and ensuring compliance with all relevant healthcare laws. This foundation enables me to lead teams through complex situations efficiently.

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What is your approach to team performance evaluations?

My approach to team performance evaluations involves qualitative and quantitative analysis. I look at key metrics to assess productivity and conduct one-on-one meetings to discuss individual strengths and areas for improvement, ultimately fostering a growth mindset within the team.

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How do you prioritize tasks in a fast-paced environment?

In a fast-paced environment, prioritizing tasks involves assessing urgency and impact. I use tools like task lists and workflow management software to stay organized, focusing first on items that affect client satisfaction and overall team performance.

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Describe a time when you improved a process in your team.

In a previous role, I identified a bottleneck in our authorization processing timeframe due to outdated procedures. By implementing a streamlined protocol for documentation and improving communication between teams, we reduced approval times by 30%, which significantly enhanced patient satisfaction.

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What is your process for onboarding new team members?

My onboarding process includes a comprehensive training plan that covers all aspects of the Prior Authorization role, followed by gradual hands-on learning opportunities. I pair new hires with seasoned team members to provide mentorship while encouraging questions and active participation.

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How do you maintain strong communication within your team?

Maintaining strong communication within my team involves regular check-ins, open-door policies, and utilizing collaboration tools. I also encourage team members to share updates or challenges in team huddles, promoting a culture of transparency and mutual support.

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What key metrics do you track for team performance?

Key metrics I track for team performance include authorization turnaround times, client satisfaction ratings, and adherence to quality assurance standards. These metrics guide my evaluations and help identify areas for improvement and training needs.

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How do you handle changes in company policies or procedures?

When handling changes in company policies or procedures, I emphasize transparency and education. I communicate changes clearly to the team, provide resources for understanding new policies, and encourage open discussions to address concerns and ensure smooth transitions.

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We started Phil with the simple conviction that the medications we take should improve our sense of wellbeing. In other words, we should not have to suffer through an inconvenient, stressful and archaic experience to ensure a consistent supply of ...

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Full-time, remote
DATE POSTED
December 5, 2024

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