Job Description:
• Process prescription prior authorization requests submitted by healthcare providers with accuracy and efficiency
• Review and research complex and compound prescriptions to support appropriate coverage decisions
• Conduct outbound outreach to providers to obtain additional or clarifying information as needed
• Partner with pharmacists by providing prior authorization recommendations based on benefit plan design and coverage guidelines
• Coordinate and process specialty medication reviews across both pharmacy and medical benefits
• Maintain up-to-date knowledge of pharmacy and medical claims processing systems and requirements
Requirements:
• Active, unrestricted Pharmacy Technician license in Arizona (AZ)
• Previous experience as a Pharmacy Technician, preferably in prior authorization, managed care, or specialty pharmacy
• Demonstrated experience with prior authorization processes, including specialty medications, precertification, and retrospective reviews
• Strong analytical and problem-solving skills with the ability to interpret clinical and benefit information
• Excellent communication skills with a focus on professionalism and customer service
• Ability to work independently in a remote environment while managing productivity and quality expectations
• Preferred Qualifications: 3 years of experience with Pharmacy Benefit Management (PBM) or prescription claims administration
• 1 year of Prior Authorization experience
• 2 years of experience handling confidential information
• Required Job Skills: Intermediate PC proficiency with word processing, spreadsheets, and claims/imaging systems
• Required Professional Competencies: Ability to establish and maintain collaborative working relationships
• Strong organizational skills with the ability to prioritize workflow
• Ability to compose clear and professional business correspondence.
• Preferred Job Skills: Advanced PC proficiency with word processing, spreadsheets, and claims/imaging systems
• Preferred Professional Competencies: Strong interpersonal communication skills
• Multicultural awareness and sensitivity
• Experience with pharmacy vendor claim systems
Benefits:
• Competitive pay: $23.00/hour
• Performance-based incentives
• Paid training in a cutting-edge virtual training environment
• Comprehensive health coverage (available after 90 days)
• Employee wellness and engagement programs.
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