Pharmacy Technician – Outpatient
Location: Portland, Oregon
Duration: 26 Weeks
Schedule
- Standard Business Hours
- On-Call Coverage: Approximately 2–3 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
- Bachelor's Degree.
- Experience with Medicare, Medicaid, Commercial, Individual, and ASO audits.
- Experience processing pharmacy claims and benefit determinations.
For more details contact at [email protected] or Call / Text at 516-862-1169.
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.
