🚀 Prior Authorization Technician

Job Summary
The Prior Authorization Technician I supports the pharmacy operations team by assisting in the review, processing, and management of prior authorization requests. This role ensures timely and accurate handling of medication authorizations in accordance with established clinical criteria and organizational policies. The technician collaborates with providers, pharmacies, and internal teams to promote efficient medication access and exceptional member service.
Key Responsibilities

Process prior authorization requests received from providers, members, and pharmacies, including those for high-cost and specialty medications.

Interpret and apply clinical criteria during the prior authorization review process and approve requests when appropriate.

Review member claims history to support prior authorization decisions.

Make outbound calls to providers and members to obtain additional information needed for review.

Submit approved authorizations to pharmacy and medical claims processors.

Forward requests to a pharmacist for clinical review when necessary.

Make referrals to other clinical programs or direct requests to in-network providers as applicable.

Handle inbound calls related to prior authorization inquiries from the customer care center.

Assist with appeals processing and other assigned administrative tasks.

Maintain productivity and quality standards while managing multiple systems and responsibilities.

Adapt to changes in a fast-paced environment with efficiency and accuracy.

Maintain strong knowledge of specialty and non-specialty pharmaceuticals.

Attend required annual training sessions and adhere to all corporate and departmental policies and procedures.

Perform additional job-related duties and projects as assigned.

Must be available to work weekends and holidays as needed.

Required Qualifications

High School Diploma or GED required.

Certified Pharmacy Technician (CPhT) through PTCB or NHA – Required.

1 to 3 years of relevant experience in pharmacy or healthcare settings.

Strong attention to detail and organizational skills.

Minimum typing speed of 35 words per minute.

Ability to multitask and work efficiently across multiple systems.

Excellent verbal and written communication skills.

Preferred Qualifications

Previous experience in one or more of the following settings:

Pharmacy Benefit Management (PBM)

Managed Care

Hospital Pharmacy

Long-Term Care (LTC

Home Infusion Pharmacy

Retail Pharmacy

Familiarity with prior authorization workflows and claims processing systems.

Certifications

• Certified Pharmacy Technician (CPhT) – Required (PTCB or NHA).

Education: High School
Certification: Certified Pharmacy Technician