Prior Authorization Technician - Pharmacy Technician Florida License required

About the Role

In this role, the individual will support patient care by removing barriers to medication access. This includes working with insurance companies and clinician offices to facilitate medication approvals through prior authorizations, as well as collaborating with patients and various funding sources, such as foundations or pharmaceutical manufacturers, to obtain financial assistance for high-cost copays. The role also involves providing phone support to patients, navigating pharmacy dispensing systems to adjudicate claims, process refills, and promote medication adherence.

Responsibilities

• Communicate directly with insurance companies to facilitate medication approvals.
• Navigate pharmacy operating systems to input data, adjudicate test claims, and develop action plans for follow-up.
• Communicate effectively across databases, electronic medical records, and email systems to document patient concerns, prior authorization status, and financial assistance needs.
• Review prescriptions with physicians’ offices to ensure optimal patient care.
• Maintain complete and accurate records of patient communications.
• Assist patients with managing their pharmacy insurance claims.
• Collaborate closely with pharmacists and pharmacy liaisons to deliver a coordinated, high-quality patient care experience.
• Communicate directly with patients via phone to support medication adherence and compliance.
• Research and analyze information to support strategic decision-making.
• Manage, organize, and update relevant data within database systems.
• Apply observations and recommendations to improve operations, productivity, quality, and customer service standards.
• Identify trends, resolve issues, recommend improvements, and implement changes.
• Participate actively in process improvement initiatives.
• Act as a value-added business partner to stakeholders across the organization.
• Protect organizational value by maintaining confidentiality of information.
• Maintain professional knowledge by participating in educational opportunities, reading professional publications, and engaging in professional networks and organizations.
• Minimal in-state or out-of-state travel may be required.
• Perform other duties as assigned.

Requirements

• 1+ years of experience as a Pharmacy Technician.
• High school diploma or GED required.
• State registered pharmacy technician (or commitment to obtain within 6 months if in a state without registration requirements, e.g., Delaware, Hawaii, New York).
• Nationally certified (PTCB or NHA) at time of hire if state does not require registration; otherwise, certification must be obtained within 9 months of employment.
• Proficiency in Microsoft Office tools (Outlook, Teams, Word, Excel, and PowerPoint) for communication, documentation, and data management.
• Strong data entry and computer skills, evaluated through a pre-employment assessment.
• Ability to navigate the internet and web-based platforms.