Pharmacy Technician Certified-Prior Authorization Specialist

Minimum 2 years experience In a healthcare or clinic setting managing medication prior authorizations is required, along with National Certification (PTCB or NHA) and TN Pharmacy Tech License.

A Brief Overview
Responsible for managing the prior authorization process for medications. This role involves verifying insurance eligibility, obtaining pre-authorizations, navigating financial assistance programs, and ensuring timely medication access for patients. The specialist collaborates with patient, pharmacies, insurance providers, and clinical teams to streamline approval workflows, document communications, track authorization requests, and follow up on denials. With expertise in insurance policies and prior authorization requirements, this position plays a vital role in ensuring continuity of care.

What you will do

• Serves as the liaison between patient, providers, pharmacy and insurance companies. • Collaborates with healthcare providers, pharmacist and insurance companies to submit accurate requests. • Stays updated on insurance policies and industry developments. • Collaborates with healthcare team for seamless communication. • Maintains patient confidentiality.
• Assists pharmacist, providers with documentation or appeals for denied requests. • Proactively track and complete prior authorization renewals. • Communicates PA outcome with patient, provider and pharmacy.
• Provides feedback to optimize the prior authorization workflow. • Ensures all actions comply with current regulations and internal protocols. • Stays updated on insurance policies and industry developments. • Assists patient/pharmacy with setting up home delivery were applicable.
• Tracks all requests through completion, including follow-ups, denials, and approvals. • Documentation and Compliance: Keeps detailed records of prior authorization activities. • KPIs Responsibilities; Patient turnaround time, other metrics.
• Identifies and elevates clinical inquiries to the pharmacist team as appropriate.

Qualifications

• Successful completion of Pharmacy Technician program or equivalent education. Required
• PHRMTECH-R - Registered Pharmacy Technician Upon Hire Required and
• LPT - Licensed Pharmacy Tech Upon Hire Required
• Minimum 2 years experience In a healthcare or clinic setting managing medication prior authorizations. Required
• Experience with EHR systems and pharmacy software. Preferred

Physical Demands

• Standing - Frequently
• Walking - Frequently
• Sitting - Frequently
• Lifting - Frequently
• Carrying - Frequently
• Pushing - Occasionally
• Pulling - Occasionally
• Climbing - Occasionally
• Balancing - Occasionally
• Stooping - Frequently
• Kneeling - Frequently
• Crouching - Frequently
• Crawling - Occasionally
• Reaching - Frequently
• Handling - Frequently
• Grasping - Frequently
• Feeling - Constantly
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Constantly
• Eye/Hand/Foot Coordination - Constantly

Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.