Prior Authorization Pharmacy Technician II
Core
Interpret moderately complex prescriptions, process prior authorizations, troubleshoot adjudication issues, and resolve grievances for Medicare and prescription benefits.
Role type
Licensed pharmacy technician (prior authorization specialist)
Builds
Prior authorization determinations and member education on prescription rules
Domain
Health insurance / Pharmacy benefits management
Deliverable
client delivery
Required skills
Prescription interpretation, data entry, Medicare compliance, grievance resolution, formulary knowledge, record keeping
Preferred skills
State Pharmacy Technician Certification, National Certification, 2+ years pharmacy experience
Technologies
Pharmacy management systems, adjudication platforms
Responsibilities
Verify member information and input data for pharmacists; Process prior authorization requests from physician offices; Inform parties of authorization determinations; Provide resolution to grievances and appeals; Respond to inquiries from physicians and members regarding formulary and benefits; Maintain records of authorizations and rebates.