Prior Authorization Pharmacy Technician II
About The Position
The Prior Authorization Pharmacy Technician II interprets and enters moderately complex prescriptions, processes prior authorizations, and troubleshoots adjudication issues. The role verifies member information and enters data for pharmacists, educates members about prescription-related pharmacy rules and medication resources or assistance programs, and processes prior authorization requests from physician offices in compliance with Medicare requirements. The technician communicates determinations to relevant parties, helps resolve grievance and appeal issues, responds to questions about formularies and prescription benefits, and maintains records of prior authorizations, rebates, and monthly reports. The role is primarily virtual full-time, apart from required in-person training sessions. Candidates must be within a reasonable commuting distance of the posting location unless an accommodation is granted. The primary location is Mason, Ohio. Shifts vary between 8 AM and 8 PM EST.
Requirements
- Active professional license, if required by state law, and State Pharmacy Technician Certification or National Certification based on applicable state requirements to practice within the scope of practice in a U.S. state or territory.
- High school diploma or equivalent and at least 2 years of pharmacy experience, or an equivalent combination of education and experience.
- For URAC-accredited areas: strong oral, written, and interpersonal communication skills; problem-solving, facilitation, and analytical skills.
Responsibilities
- Verify member information and enter data for pharmacists.
- Educate members on pharmacy rules related to prescriptions and on medication resources or assistance programs.
- Process prior authorization requests from physician offices and ensure compliance with Medicare requirements.
- Inform relevant parties of prior authorization determinations.
- Provide resolution to grievance and appeal issues.
- Respond to inquiries from physicians, the sales team, and members about formularies and prescription benefits.
- Maintain records of prior authorizations, rebates, and monthly reports.
- Interpret and enter moderately complex prescriptions, process prior authorizations, and troubleshoot adjudication issues.
Benefits
- Merit increases
- Paid holidays
- Paid time off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental insurance
- Vision insurance
- Short- and long-term disability benefits
- 401(k) with matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
