Pharmacy Technician

Job Description

We are seeking a dedicated Pharmacy Technician to join a reputable healthcare insurance company's Pharmacy Services department. The role involves reviewing Prior Authorizations for determination, handling health plans, and various medication types. Technicians are responsible for approving or denying requests and forwarding them to pharmacists for final review, with minimal phone interactions with members.

Responsibilities

• Track coverage determination requests submitted from providers and determine if a pharmacist review is required.
• Obtain verbal authorizations and request detailed clinical information from prescribers.
• Approve coverage determination requests based on defined criteria.
• Enter and document coverage determination request decisions into the PBM system and notify providers and/or members.
• Respond to client inquiries regarding authorization approvals and PBM online applications.
• Refer coverage determination requests for specialty drugs to a delegated vendor or client for processing.
• Contact providers for additional information to facilitate coverage determination reviews.
• Notify physicians, providers, and members of coverage determination request decisions.

Essential Skills

• Registered Pharmacy Technician in the state of residence.
• High School Diploma or GED.
• Current Pharmacy Registration and Certification as required by the state of operation.
• Strong computer skills, including proficiency in Microsoft Office and Outlook.
• Experience with prior authorization processes.
• Excellent customer service skills.

Additional Skills & Qualifications

• Nationally Certified Technician is a plus and required for some supervisory roles.
• Experience in call center, PBM, hospital, or specialty pharmacy settings is advantageous.
• Strong data entry skills.
• Experience handling prescription benefits.

Work Environment

This position is in a professional remote environment, requiring a strong Wi-Fi connection and a personal office space with a closed door. The job involves working on multiple screens and systems. The company provides necessary equipment including a computer, monitor, and headset. The work schedule is flexible, with shifts primarily Monday to Friday, 8 am-7 pm in the local time zone, including rotating weekends every 4-6 weeks and some holidays.