Prior Authorization Technician

Overview

We are looking for a Prior Authorization Technician (RX) to join our Clinical Department. In this role, you aren’t just processing paperwork, you are the vital link between patients and the life-changing medications they need. Working directly under the guidance of Clinical Pharmacists, you will use your expertise to navigate complex pharmacy benefits, ensure clinical accuracy, and advocate for timely patient care.

• High level understanding of medical/pharmacy terminology and formulary structures.
• Ability to balance high-volume productivity with extreme attention to detail.
• Excellent verbal and written communication skills for interacting with healthcare providers and internal departments.
• Licensed Pharmacy Technician (CPhT highly preferred / will consider applicants with state license/registrations that have 3+ years of experience).
• HIPAA savvy with an eye for detail and 3+ years working in a pharmaceutical setting.

Your clinical expertise can help to change a patient s life! If you’re a HIPAA savvy pro with an eye for detail and 3+ years working in pharmaceutical setting, we want to meet you! Please apply today!

Salary: $20 - $22 per hour

Shift: First

Work hours: 8 AM - 5:30 PM

Education: High School

• Processing: Initiate, research, and resolve prior authorization requests and appeals within automated systems, ensuring all productivity and quality metrics are met.
• Clinical Determination: Interpret pharmacy benefit coverage, clinical criteria, and formulary alternatives to provide accurate determinations.
• Professional Liaison: Serve as the primary point of contact for members and providers regarding prior auth status, inquiries, and grievances.
• Documentation & Reporting: Meticulously document all outcomes and assist in generating program statistics and key performance metrics for management.
• Clinical Escalation: Identify and escalate complex cases requiring extensive clinical review or potential denial to the Clinical Pharmacist.
• Process Improvement: Assist in developing departmental procedures, training materials, and desk-level documentation as systems evolve.

• Strictly adhere to all HIPAA regulations regarding Protected Health Information (PHI).
• Maintain a high level of accuracy and demonstrate competency in all required clinical and compliance training.
• Remain adaptable to shifting priorities and new responsibilities as assigned by the Clinical Manager.

• Skills
  — Pharmaceutical, CPhT, Pharmacy Technician, HIPAA, PHI, Healthcare, Prior Authorizations, Confidentiality, Pharmacy Tech Certification
• Experience
  — 3 years

Note:

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