Pharmacy Technician – Outpatient - PTO26-07202
NavitasPartners•Portland, OR
•Onsite
About The Position
Navitas Healthcare, LLC is seeking an experienced Pharmacy Technician to support pharmacy operations, pharmacy benefit administration, and prior authorization processes within a managed care environment. The ideal candidate will possess strong pharmacy benefit management experience, prior authorization expertise, advanced analytical skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.
Requirements
- Active Oregon Pharmacy Technician License.
- Minimum 2 years of Pharmacy Technician experience in a managed care environment.
- Experience handling pharmacy prior authorization reviews.
- Experience within managed care, health plan operations, PBM, or utilization management environments.
- Advanced Microsoft Excel skills.
- Strong knowledge of pharmacy benefits, claims processing, reimbursement, and utilization management.
- Excellent analytical, organizational, communication, and customer service skills.
Nice To Haves
- Bachelor's Degree.
- Experience with Medicare, Medicaid, Commercial, Individual, and ASO audits.
- Experience processing pharmacy claims and benefit determinations.
Responsibilities
- Process and coordinate pharmacy prior authorization requests according to benefit policies and utilization management guidelines.
- Review authorization requests, supporting documentation, and medication utilization criteria.
- Escalate complex cases to Clinical Pharmacists or Medical Directors when necessary.
- Communicate authorization decisions and medication requirements to providers and prescribers.
- Support pharmacy benefit administration and pharmacy network operations.
- Monitor pharmacy claims transactions and eligibility processes.
- Research and resolve pended claims, reimbursement requests, and authorization issues.
- Process pharmacy claims payments and Direct Member Reimbursements (DMRs).
- Audit pharmacy claims and documentation for accuracy and compliance.
- Provide exceptional customer service to members, providers, and pharmacies.
- Respond to inquiries regarding pharmacy benefits, claims, and prior authorizations.
- Resolve complex benefit and medication-related issues.
- Maintain pharmacy databases and member eligibility information.
- Analyze operational and clinical data using advanced Excel functions.
- Develop reports to support quality improvement and operational performance.
- Apply ICD-10, CPT, HCPCS, and pharmacy coding knowledge to support claims and authorization reviews.
- Assist with documentation review and coding validation.
- Train staff and providers on pharmacy processes and systems.
- Develop workflow documentation and job aids.
- Participate in process improvement and quality initiatives.
- Maintain compliance with HIPAA, pharmacy regulations, and health plan requirements.
- Monitor for fraud, waste, and abuse concerns.
- Support audits and regulatory reviews as needed.
Benefits
- Most competitive pay for every position
- Salary will be discussed upfront
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
