Clinical Pharmacy Technician II
About The Position
The Clinical Pharmacy Technician II supports pharmacy benefits, insurance processes, and patient access procedures. The role coordinates and administers pharmacy benefits prior authorization processing, insurance evaluations, resolution of medication access issues, medication reconciliation, and referral screening and management. It also supports accurate and timely processing of services determined to be medically necessary, assists patients seeking affordable medications, and maintains regulatory compliance while resolving cases within established timeframes. The position requires compliance with applicable laws, company policies, HIPAA privacy requirements, and information security guidelines. Employees may have access to confidential customer information and are responsible for protecting it.
Requirements
- Two years of experience as a Pharmacy Technician, Patient Access Coordinator, or Medical Assistant in a health care setting.
Nice To Haves
- Associate degree.
- Certified Pharmacy Technician (CPhT) certification from the Pharmacy Technician Certification Board.
Responsibilities
- Review pharmacy utilization management coverage requests for pharmacy and medical benefits, prepare cases for clinical review when needed, apply plan-specific benefits, summarize relevant facts, and cite applicable policies and guidelines.
- Resolve non-clinical issues independently and serve as a liaison among customers, provider-facing teams, and the Pharmacy Department.
- Conduct member and provider outreach to address appeal initiation requests, processing errors, and notification requirements.
- Schedule appointments, verify patient information, and respond to inquiries.
- Screen and process referrals, coordinate with specialists, and support timely patient access to services.
- Enter preauthorization information into applicable databases, including internal medical claims and PBM pharmacy systems.
- Evaluate insurance eligibility and coverage for services.
- Perform medication reconciliation to maintain accurate medication lists and help prevent potential drug interactions.
- Maintain regulatory compliance and resolve cases within predetermined timeframes.
- Assist patients with applications for affordable medications.
- Perform other duties as assigned or requested.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
