Prior Authorization Technician I

Job Summary

The Prior Authorization Technician I plays a critical role in supporting pharmacy operations by efficiently processing prior authorization requests for medications including high-cost and specialty drugs. This position directly impacts patient access to required therapies and ensures compliance with clinical and corporate guidelines. The technician collaborates closely with providers pharmacies and internal teams requiring strong multitasking abilities and a comprehensive understanding of pharmaceutical processes.

Emphasis on Skills

- Certified Pharmacy Technician (PTCB or NHA) required
- Proficiency in interpreting clinical criteria
- Strong multitasking and communication skills
- Knowledge of specialty and non-specialty pharmaceuticals
- Minimum typing speed of 35 words per minute

Key Responsibilities

- Process prior authorization requests from providers members and pharmacies
- Apply clinical criteria and approve requests when applicable
- Utilize member claims history during review
- Make outbound calls to obtain additional information
- Submit authorizations to claims processors
- Forward requests to a pharmacist as needed
- Refer requests to appropriate clinical programs or in-network providers
- Receive and resolve inbound calls regarding prior authorization inquiries
- Assist with appeals processing as assigned
- Maintain productivity and quality standards in a fast-paced environment
- Attend required annual training and adhere to corporate policies
- Work flexible hours including weekends and holidays

Recruiter Insights

- High-impact non-clinical role within a leading pharmacy benefit management organization
- Opportunity to work with specialty medications and clinical criteria
- Competitive advantage for candidates with PBM managed care hospital LTC home infusion or retail pharmacy experience
- Stable full-time schedule with training opportunities and professional development

Candidate Insights

- Direct involvement in patient care processes and access to high-cost therapies
- Gain valuable experience in pharmacy operations and prior authorization procedures
- Ideal for certified pharmacy technicians seeking career growth within a respected healthcare organization
- Supportive environment with opportunities for skill enhancement and advancement