Central Prior Authorization Pharmacy Tech
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Job Description
Pharmacy technician coordinating specialty-drug prior authorizations for Apotheco’s pharmacy services. Managing payer submissions, documentation, insurance verification, and prescription access remotely.
Responsibilities:
- Manage and process prior authorization requests for specialty medications
- Communicate with provider offices, patients, payers, and specialty pharmacies to obtain clinical documentation and authorization approvals
- Submit, monitor, and track prior authorization requests through payer portals, fax, phone, and electronic systems
- Follow up on pending prior authorizations, appeals, renewals, and denials to ensure timely patient access
- Verify patient insurance coverage, benefits, and specialty pharmacy requirements
- Input necessary data into the pharmacy management system and maintain up-to-date project information
- Receive, analyze, gather, and organize data from multiple sources
- Accurately enter required data into databases, documents, or spreadsheets
- Collaborate with pharmacy operations, sales, and data teams
- Support existing data projects
- Use the pharmacy system to obtain patient and drug information and process prescriptions
- Manage prescription refills for integrated offices
- Apply manufacturer copay cards when applicable
- Adhere to company policies, confidentiality standards, information security policies, and privacy requirements
- Participate in continuous quality improvement activities
Requirements:
- Pharmacy Technician Experience
- Experience with specialty medications and prior authorization processes preferred
- Knowledge of commercial, Medicare, and Medicaid insurance plans
- Familiarity with specialty pharmacy workflows and reimbursement procedures
- Familiarity with the prescription adjudication process
- Ability to learn pharmacy management systems to extrapolate pertinent data
- Ability to communicate effectively within various levels of the organization
- Ability to read, comprehend, and write correspondence
- Ability to present information effectively in one-on-one and small group situations
- Ability to comprehend and apply principles of basic math
- Ability to apply common sense understanding
- Strong analytical and problem-solving skills
- Excellent interpersonal, negotiation, and conflict resolution skills
- Proficiency in Word and Excel or related software
- Comfortable using RingCentral and experience with patient outreach
- Experience using payer portals such as CoverMyMeds or similar authorization platforms preferred
- Compliance with Apotheco information security policies, employee handbook, and security and privacy regulatory requirements
- Time management, oral and written communication, professionalism, organization, customer service, prioritization, attention to detail, multitasking, goal orientation, dependability, confidentiality, and self-motivation
- Ability to work well with various departments and within a team
Benefits:
- Remote, home-based position
- Reliable internet access and private workspace for confidential patient interactions
- Reasonable accommodation may be made for individuals with disabilities
- Continuous quality improvement activities
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