Pharmacy Technician
Core
Managing and coordinating medication prior authorization requests across all clinics to ensure timely approval of prescribed medications and continuity of care.
Role type
Pharmacy Technician – Prior Authorization Specialist
Builds
Medication access and continuity of care for patients across primary and specialty care clinics
Domain
Healthcare / Pharmacy Benefit Management
Deliverable
client delivery
Required skills
processing prior authorization requests, reviewing clinical documentation, navigating payer portals, communicating with providers and insurance carriers, managing high-volume workloads, knowledge of pharmacy terminology and insurance benefit structures
Preferred skills
Certified Pharmacy Technician (CPhT) credential, experience with electronic prior authorization platforms, knowledge of specialty medications and high-cost therapeutics, familiarity with population health models
Technologies
electronic health records (EHR), payer authorization portals, Microsoft Office
Responsibilities
Process medication prior authorization requests for all clinic locations in accordance with payer requirements; Review patient charts and clinical documentation to ensure completeness prior to submission; Collaborate with providers and clinical staff to obtain supporting clinical information; Submit prior authorization requests through payer portals, electronic systems, fax, or phone; Monitor authorization status and follow up with insurance companies to expedite approvals; Communicate authorization determinations, denials, and appeals requirements to providers and clinic teams; Maintain accurate documentation of all authorization activities within the electronic health record (EHR)
Seniority
Entry-level to Mid-level, hands-on operational role