Prior Authorization Pharmacy Technician Jobs

Experience handling prior authorization requests/understanding of prior authorization requirements required

2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting

Excellent communication, writing, and organizational skills

Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment

Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines

Review and analyze pharmacy claims data for proactive outreach and intervention.

Deliver consistently outstanding experiences in every interaction, whether through inbound and outbound calls, face-to-face discussions, online chats, or email correspondences.

A minimum of 1 year of experience as a pharmacy technician, involving coordination of activities in an administrative support capacity.

Possession of national pharmacy technician certification.

Prior experience with prior authorizations.

Eligibility for state registration certification or licensure in accordance with state regulations.

Proficiency in advanced computer skills, including word processing and spreadsheet utilization.

Organize and prioritize multiple requests internally and externally to ensure timely prior authorization case management.

Verify eligibility and drug coverage under the plan benefit design to determine appropriate claims processing

Use pharmacy technician experience to navigate drug products, formulations, and perform basic calculations to check and monitor accurate claims adjudication.

High School diploma or GED or equivalent work experience

2-4 years of experience as a Pharmacy Technician

2+ years of experience in prior authorization review (specifically working on the approval side at a PBM or health plan) required

4. Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.

Physical Requirements [ex. Sit, stand, stoop, bend and walk]

- Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

- Must possess excellent written, verbal, grammar, and listening communication skills.

Example: Lifts, scans and bags purchased items

1. Regular and predictable attendance