Summary: The Central Prior Authorization Pharmacy Technician will serve as the primary coordinator for specialty medication prior authorizations (PAs), ensuring timely processing and approval of specialty drug therapies. This role will work closely with prescribers, patients, insurance providers, specialty pharmacies and internal pharmacy teams to facilitate medication access, obtain required documentation, track authorization statuses, and support reimbursement process. This position requires strong organizational skills, attention to detail and knowledge of specialty pharmacy and insurance workflows.
This position can be remote, home-based position requiring reliable internet access and a private workspace for confidential patient interactions. Must adhere to all company policies, procedures, confidentiality standards and security protocols applicable to remote employees.
Duties and Responsibilities include the following; other duties may be assigned;
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Manager and process prior authorization requests for specialty medications.
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Communicate with provider offices, patients, payers and specialty pharmacies to obtain clinical documentation and authorization approvals.
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Submit, monitor and track PA requests through payer portals, fax, phone and electronic systems.
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Follow up on pending PAs, appeals, renewals, and denials to ensure timely patient access.
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Verify patient insurance coverage, benefits, and specialty pharmacy requirements.
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Input all necessary data into the pharmacy management system to track and maintain up-to-date project information.
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Receive, analyze, gather, and organize data from multiple sources.
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Accurately enter required data into one or more databases, documents, or spreadsheets.
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Work closely with different functional departments including but not limited to pharmacy operations, sales, and data team.
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Support all existing data projects.
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Use pharmacy system to obtain patient and drug information and process prescriptions.
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Manage prescription refills for integrated offices.
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Apply manufacturer copay cards if applicable.
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Pharmacy Technician Experience.
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Experience with specialty medications and prior authorization processes preferred.
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Knowledge of commercial, Medicare, and Medicaid insurance plans.
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Familiarity with specialty pharmacy workflows and reimbursement procedures.
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Familiar with the prescription adjudication process.
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Ability to learn pharmacy management systems to extrapolate pertinent data.
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Ability to communicate effectively within various levels of the organization.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and be able to manage other required tasks. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Language Ability: Ability to read, comprehend, and write correspondence. Need to be able to effectively present information in one-on-one and small group situations to all employees of the organization.
Math Ability: Ability to comprehend and apply principles of basic math.
Reasoning Ability: Ability to apply common sense understanding. Strong analytical and problem-solving skills. Need to have excellent interpersonal, negotiation, and conflict resolution skills.
Computer Skills: To perform this job successfully, an individual should be:
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Proficient in Word and Excel. or related software;
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Comfortable using RingCentral and experience with patient outreach;
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Experience using payer portals such as CoverMyMeds or similar authorization platforms preferred.
Information Security Expectations: While performing the duties of this job, the employee is required to abide by Apotheco information security policies, employee handbook and security and privacy regulatory requirements. Each employee is responsible for the secure and appropriate handling of Apotheco information, information received by customers, other companies and/or external parties.
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Time management
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Oral and written communication skills
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Professionalism
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Organization skills
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Customer Service
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Prioritizing skills
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Detail-oriented
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Multi-task abilities
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Goal-oriented
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Dependable
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Confidentiality
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Self-motivated
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Ability to work well with various departments and within a team.
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Participate in continuous quality improvement activities
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to walk; sit and use hands. The employee is occasionally required to stand.
