Job Title: Pharmacy Technician I Prior Authorization
Job Location: 100% Remote Job Duration: 12 Months
Summary: The Pharmacy Technician I Prior Authorization will provide professional and courteous support to members, providers, pharmacies, and other callers throughout the prior authorization process. The role involves handling high-volume inbound calls, processing and documenting prior authorization requests, and ensuring accurate and timely completion of reviews based on established criteria. Clinical questions, escalations, and judgment-based decisions will be transferred to the pharmacist team.
Responsibilities:
Handle high-volume inbound calls from providers, pharmacies, members, and other healthcare stakeholders.
Provide professional and courteous customer service while assisting callers with prior authorization inquiries.
Process prior authorization requests using established criteria and procedures.
Maintain complete, accurate, and timely documentation of prior authorization reviews, approvals, and denials.
Escalate clinical questions, complex cases, and judgment calls to the pharmacist team.
Process prior authorization requests received through fax and online portals.
Make outbound calls as required to obtain or provide information.
Monitor and respond to department mailboxes and other inquiries.
Navigate multiple computer systems simultaneously while handling calls and documenting information.
Utilize MS Teams, Outlook, Word, Excel, and other computer applications.
Perform additional administrative and pharmacy-related duties as assigned by leadership.
Maintain confidentiality and work within HIPAA requirements while working remotely.
Experience:
Minimum 1 year of high-volume inbound call center experience; healthcare, insurance, PBM, pharmacy, or medical-office experience preferred.
Active Pharmacy Technician license, certification, or trainee license preferred but not required.
Prior Authorization experience is strongly preferred.
Strong customer service, verbal communication, and written communication skills.
Advanced computer and data-entry skills with the ability to multitask across multiple systems.
Proficiency with MS Teams and Outlook required; working knowledge of Word and Excel preferred.
Must be comfortable working remotely with a private HIPAA-compliant workspace.
Must have a hardwired internet connection with minimum speeds of 25 Mbps download / 3 Mbps upload.
Must be available for approximately six weeks of training, Monday Friday, 8:00 AM 4:30 PM CST.
After training, must be available for an assigned 8-hour Monday Friday shift between 8:00 AM CST and 12:00 AM CST, with potential weekend requirements.
Candidates must meet all requirements below:
Hardwired internet connection required (Wi-Fi only is not acceptable)
Internet speed test screenshot required with submission
Minimum 25 Mbps download and 3 Mbps upload
Private, HIPAA-compliant workspace required
Ability to work on a computer for the duration of the shift
Smartphone required for use of the PING application