Pharmacy Technician/Prior Authorization Specialist

Pancare of Florida Inc•Panama City, FL

About The Position

PanCare is looking for a dedicated and detail-oriented Prior Authorization Specialist to become an essential part of our team. In this role, you will be at the heart of the process, ensuring that patients get the medications they need without delay. By managing and coordinating prior authorizations for prescriptions, you’ll play a crucial part in breaking down barriers to care and helping our patients access the treatments they deserve. If you’re an expert communicator with a deep understanding of insurance processes and pharmaceutical practices, and you're ready to make a lasting impact, this is the opportunity for you! Join PanCare and be part of a mission-driven team focused on providing the highest quality care to all our patients.

Requirements

High school diploma or equivalent (required); Associate’s degree in health-related field preferred.
Minimum of 1-2 years of prior authorization experience, preferably in a pharmacy setting. Knowledge of insurance plans, pharmacy benefits, and prior authorization processes. Familiarity with pharmacy management systems and tools used for prior authorization requests is a plus. Pharmacy Technician experience preferred.
Must have Pharmacy Tech Licensure
Strong attention to detail and accuracy in data entry and documentation.
Excellent communication skills, both written and verbal, with the ability to interact with patients, healthcare providers, and insurance companies professionally.
Ability to multitask and prioritize work in a fast-paced environment.
Problem-solving skills, especially in addressing denied authorizations and appeals.
Knowledge of HIPAA guidelines and confidentiality protocols.

Responsibilities

Submit and follow up on prior authorization requests for medications as required by insurance companies.
Ensure the necessary documentation and clinical information is provided to support authorization requests.
Review prescriptions and medical records to determine which medications require prior authorization.
Communicate with healthcare providers to gather necessary information and ensure timely completion of the prior authorization process.
Verify patient insurance coverage and identify medications that are subject to prior authorization requirements.
Work closely with insurance providers to confirm the status of prior authorization requests, appeals, and reauthorizations.
Notify patients and healthcare providers of the status of prior authorization requests and provide guidance on next steps if necessary.
Address any concerns or questions related to prior authorization status and medication access.
Assist patients in navigating their insurance benefits and help them understand the prior authorization process.
Initiate and track appeals for denied prior authorization requests and work to resolve issues promptly.
Monitor reauthorization timelines and ensure that medications continue to be covered without interruption.
Maintain accurate records of prior authorization requests, approvals, denials, appeals, and follow-ups.
Stay updated on insurance policies, formularies, and medication coverage changes to ensure compliance with industry standards and regulations.
Work closely with pharmacists, pharmacy technicians, and healthcare providers to ensure a seamless process for patients requiring prior authorizations.
Collaborate with internal teams to address any medication-related issues and provide feedback for process improvements.

Benefits

PanCare provides a comprehensive benefits package to include medical, dental and vision insurance.
In addition, to health coverage, we offer 14 paid holidays and 3 weeks of paid vacation per year.
Employees are also eligible to participate in our 403(b) plan with a 6% employer match and 3% base employer contribution.

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