Prior Authorization Technician - Pharmacy Technician

6 days, 10 hours ago
Junior
Customer and Technical Support
Shields Health Solutions

Shields Health Solutions

Shields Health Solutions is the first and largest company in the nation to integrate specialty pharmacies within hospitals, focusing on improving patient outcomes and system-wide growth. Their programs and data platforms reduce costs, achieve better cl...

Health Care Providers & Services
1K-5K
Founded 2012

Description

  • Communicate directly with insurance companies to facilitate approval of medications, including prior authorizations.
  • Navigate pharmacy operating/dispensing systems to input data, adjudicate test claims, and prepare follow-up action plans.
  • Document patient concerns, prior authorization status, and financial assistance needs across databases, electronic medical records, and email.
  • Review prescriptions with clinicians' offices to ensure optimal patient care and resolve prescription issues.
  • Maintain complete and accurate records of patient communications and insurance claim activities.
  • Provide phone support to patients to assist with medication adherence, refills, and management of pharmacy insurance claims.
  • Work closely with pharmacists and pharmacy liaisons to deliver integrated, quality patient care.
  • Research and investigate information, identify trends and problems, recommend improvements, and participate in process improvement initiatives.
  • Manage, organize, and update relevant data using database applications while protecting confidential information.
  • Perform other duties as assigned and may require minimal in- or out-of-state travel.

Requirements

  • State-registered or state-certified Pharmacy Technician required.
  • National pharmacy technician certification (CPhT) strongly preferred; required at time of hire if the candidate's state does not offer state registration.
  • 1+ years of experience as a Pharmacy Technician.
  • High school diploma or GED required.
  • Willingness to obtain any additional licensure required by the employer within an agreed timeframe as a condition of continued employment.
  • Experience using pharmacy dispensing/operating systems, electronic medical records, and database applications to adjudicate claims and document patient information.
  • Strong verbal communication skills for frequent phone interactions with patients, insurance companies, and clinician offices.
  • Ability to handle confidential patient information in accordance with privacy policies and regulations.
  • Ability to travel minimally in- or out-of-state as required.

Interested in this position?

Apply directly on the company website

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