Central Prior Authorization Pharmacy Technician

Job Description:

• Manage and process prior authorization requests for specialty medications
• Communicate with provider offices, patients, payers, and specialty pharmacies to obtain clinical documentation and authorization approvals
• Submit, monitor, and track prior authorization requests through payer portals, fax, phone, and electronic systems
• Follow up on pending prior authorizations, appeals, renewals, and denials to ensure timely patient access
• Verify patient insurance coverage, benefits, and specialty pharmacy requirements
• Enter data into the pharmacy management system and maintain up-to-date project information
• Receive, analyze, gather, and organize data from multiple sources
• Accurately enter required data into databases, documents, or spreadsheets
• Collaborate with pharmacy operations, sales, and data teams
• Support existing data projects
• Use the pharmacy system to obtain patient and drug information and process prescriptions
• Manage prescription refills for integrated offices
• Apply manufacturer copay cards when applicable
• Follow company policies, procedures, confidentiality standards, and remote-work security protocols
• Participate in continuous quality improvement activities

Requirements:

• Pharmacy Technician Experience
• Experience with specialty medications and prior authorization processes preferred
• Knowledge of commercial, Medicare, and Medicaid insurance plans
• Familiarity with specialty pharmacy workflows and reimbursement procedures
• Familiarity with the prescription adjudication process
• Ability to learn pharmacy management systems to extrapolate pertinent data
• Ability to communicate effectively within various levels of the organization
• Ability to read, comprehend, and write correspondence
• Ability to present information effectively in one-on-one and small group situations
• Ability to comprehend and apply principles of basic math
• Ability to apply common sense understanding
• Strong analytical and problem-solving skills
• Excellent interpersonal, negotiation, and conflict resolution skills
• Proficient in Word and Excel or related software
• Comfortable using RingCentral and experience with patient outreach
• Experience using payer portals such as CoverMyMeds or similar authorization platforms preferred
• Ability to abide by Apotheco information security policies, employee handbook, and security and privacy regulatory requirements
• Time management, oral and written communication, professionalism, organization, customer service, prioritizing, multitasking, goal orientation, dependability, confidentiality, and self-motivation
• Ability to work well with various departments and within a team
• Participate in continuous quality improvement activities
• Must have reliable internet access and a private workspace for remote work

Benefits:

• Remote, home-based position
• Reliable internet access and private workspace for confidential patient interactions
• Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions