Prior Authorization Pharmacy Technician - 253054
Medix™, New York, NY, United States
The Prior Authorization (PA) Technician supports the medication utilization review process by assisting with the intake, evaluation, and coordination of prior authorization requests. This role works closely with healthcare providers, pharmacies, members, and internal teams to ensure timely and accurate processing of medication requests in alignment with plan guidelines, regulatory requirements, and company service standards.
This position requires exceptional attention to detail, strong communication skills, and the ability to manage multiple priorities in a fast-paced environment. The PA Technician plays a critical role in supporting member access to appropriate medications while upholding the organization’s commitment to transparency, integrity, and superior service.
Key Responsibilities
To perform this role successfully, an individual must be able to execute the following essential functions:
Review and evaluate prior authorization requests to determine coverage eligibility based on plan guidelines and clinical criteria.
Collaborate with healthcare providers and pharmacies to obtain necessary documentation, clarify prescription needs, and support accurate review.
Initiate prior authorization renewals and conduct outreach to gather required information.
Communicate prior authorization decisions, including approvals, denials, and follow-up requirements, to providers, pharmacies, and members.
Maintain accurate and detailed records of request status, documentation, determinations, and follow-up actions within internal systems.
Support appeals, reconsiderations, and additional review processes as needed.
Identify opportunities for workflow and process improvements to enhance operational efficiency and service quality.
Ensure compliance with regulatory requirements, plan policies, and internal procedures related to prior authorization operations.
Provide timely updates, administrative support, and coordination assistance to internal clinical and operational teams.
Perform additional duties as assigned.
Required Qualifications
Experience in a PBM, PBM-adjacent, health plan, or pharmacy-related environment.
Strong understanding of prior authorization processes and insurance benefit guidelines.
Exceptional attention to detail, organizational skills, and documentation accuracy.
Excellent communication, customer service, and problem-solving abilities.
Ability to effectively manage multiple priorities and deadlines in a fast-paced setting.
Active Pharmacy Technician license.
Preferred Qualifications
Pharmacy Technician Certification (PTCB or equivalent).
Familiarity with pharmacy claims processing, prior authorization platforms, and formulary structures.
Proven ability to collaborate effectively with both internal and external stakeholders.
This position requires exceptional attention to detail, strong communication skills, and the ability to manage multiple priorities in a fast-paced environment. The PA Technician plays a critical role in supporting member access to appropriate medications while upholding the organization’s commitment to transparency, integrity, and superior service.
Key Responsibilities
To perform this role successfully, an individual must be able to execute the following essential functions:
Review and evaluate prior authorization requests to determine coverage eligibility based on plan guidelines and clinical criteria.
Collaborate with healthcare providers and pharmacies to obtain necessary documentation, clarify prescription needs, and support accurate review.
Initiate prior authorization renewals and conduct outreach to gather required information.
Communicate prior authorization decisions, including approvals, denials, and follow-up requirements, to providers, pharmacies, and members.
Maintain accurate and detailed records of request status, documentation, determinations, and follow-up actions within internal systems.
Support appeals, reconsiderations, and additional review processes as needed.
Identify opportunities for workflow and process improvements to enhance operational efficiency and service quality.
Ensure compliance with regulatory requirements, plan policies, and internal procedures related to prior authorization operations.
Provide timely updates, administrative support, and coordination assistance to internal clinical and operational teams.
Perform additional duties as assigned.
Required Qualifications
Experience in a PBM, PBM-adjacent, health plan, or pharmacy-related environment.
Strong understanding of prior authorization processes and insurance benefit guidelines.
Exceptional attention to detail, organizational skills, and documentation accuracy.
Excellent communication, customer service, and problem-solving abilities.
Ability to effectively manage multiple priorities and deadlines in a fast-paced setting.
Active Pharmacy Technician license.
Preferred Qualifications
Pharmacy Technician Certification (PTCB or equivalent).
Familiarity with pharmacy claims processing, prior authorization platforms, and formulary structures.
Proven ability to collaborate effectively with both internal and external stakeholders.