Prior Authorization Specialist – Allergy & Immunology (Specialty Pharmacy)

About the role

RagaAI is seeking a Prior Authorization Specialist with hands‑on experience in allergy and immunology. You will support the development of Ivy’s autonomous prior‑auth agents by applying real‑world knowledge of payer workflows, specialty pharmacy coordination, and biologic drug approvals.

Key responsibilities

• Manage and validate prior‑authorization workflows for biologic medications such as Dupixent, Xolair, Nucala, Fasenra, Tezspire, and IVIG/SubQ therapies.
• Submit PA requests through medical‑benefit portals (Availity, NaviNet, UHC, Aetna, Cigna, BCBS) and pharmacy‑benefit platforms (CoverMyMeds, Surescripts CompletEPA).
• Coordinate enrollment, benefits investigation, shipment scheduling, and refill management with specialty pharmacies (Accredo, BriovaRx, AllianceRx Walgreens, Optum Specialty, CVS Specialty, PANTHERx).
• Determine optimal routing (buy‑and‑bill vs. specialty pharmacy) based on plan design, formulary, and cost‑sharing.
• Track PA expiration dates, renewal timelines, and step‑therapy requirements.
• Handle denials, schedule peer‑to‑peer reviews, and draft appeal letters using LCD/medical policy criteria.
• Validate AI‑generated PA submissions for clinical accuracy and payer‑specific formatting.
• Support manufacturer copay assistance and patient access programs (e.g., Dupixent MyWay, Xolair Co‑pay Program).

Required profile

• Minimum 1 year of prior‑authorization experience in an allergy, immunology, pulmonology, rheumatology practice, or specialty pharmacy setting.
• Experience with both medical‑benefit (buy‑and‑bill) and pharmacy‑benefit PA pathways.
• Hands‑on coordination with specialty pharmacies for biologic medications.

Required skills

• Proficiency with payer portals: Availity, NaviNet, UHC, Aetna, Cigna, BCBS.
• Experience using pharmacy‑benefit platforms: CoverMyMeds, Surescripts CompletEPA.
• Familiarity with specialty pharmacy systems: Accredo, BriovaRx, AllianceRx Walgreens, Optum Specialty, CVS Specialty, PANTHERx.