Pharmacy Technician – Outpatient PTO26-07202

Pharmacy Technician Outpatient

Location: Portland Oregon

Duration: 26 Weeks

Schedule
Standard Business Hours
On-Call Coverage: Approximately 23 weekends per year

Pay Rate: $33 - $37 per hour (Depending on Experience)

Position Overview

Navitas Healthcare LLC is seeking an experienced Pharmacy Technician to support pharmacy operations pharmacy benefit administration and prior authorization processes within a managed care environment. The ideal candidate will possess strong pharmacy benefit management experience prior authorization expertise advanced analytical skills and the ability to manage multiple priorities in a fast-paced healthcare environment.

Key Responsibilities

Prior Authorization & Pharmacy Benefits Administration

Process and coordinate pharmacy prior authorization requests according to benefit policies and utilization management guidelines.
Review authorization requests supporting documentation and medication utilization criteria.
Escalate complex cases to Clinical Pharmacists or Medical Directors when necessary.
Communicate authorization decisions and medication requirements to providers and prescribers.

Pharmacy Operations & Claims Processing

Support pharmacy benefit administration and pharmacy network operations.
Monitor pharmacy claims transactions and eligibility processes.
Research and resolve pended claims reimbursement requests and authorization issues.
Process pharmacy claims payments and Direct Member Reimbursements (DMRs).
Audit pharmacy claims and documentation for accuracy and compliance.

Member & Provider Support

Provide exceptional customer service to members providers and pharmacies.
Respond to inquiries regarding pharmacy benefits claims and prior authorizations.
Resolve complex benefit and medication-related issues.

Data Management & Reporting

Maintain pharmacy databases and member eligibility information.
Analyze operational and clinical data using advanced Excel functions.
Develop reports to support quality improvement and operational performance.

Coding & Clinical Support

Apply ICD-10 CPT HCPCS and pharmacy coding knowledge to support claims and authorization reviews.
Assist with documentation review and coding validation.

Training & Process Improvement

Train staff and providers on pharmacy processes and systems.
Develop workflow documentation and job aids.
Participate in process improvement and quality initiatives.

Compliance & Regulatory Responsibilities

Maintain compliance with HIPAA pharmacy regulations and health plan requirements.
Monitor for fraud waste and abuse concerns.
Support audits and regulatory reviews as needed.

Required Qualifications

Active Oregon Pharmacy Technician License.
Minimum 2 years of Pharmacy Technician experience in a managed care environment.
Experience handling pharmacy prior authorization reviews.
Experience within managed care health plan operations PBM or utilization management environments.
Advanced Microsoft Excel skills.
Strong knowledge of pharmacy benefits claims processing reimbursement and utilization management.
Excellent analytical organizational communication and customer service skills.

Preferred Qualifications

Bachelors Degree.
Experience with Medicare Medicaid Commercial Individual and ASO audits.
Experience processing pharmacy claims and benefit determinations.

For more details contact at or Call / Text at .

About Navitas Healthcare LLC:
It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.