- Review, research, and process pharmacy prior authorization requests according to established criteria, policies, regulatory requirements, and service-level agreements
- Research and resolve member, provider, and pharmacy inquiries and escalations
- Provide accurate information and appropriate follow-up
- Document calls, authorization activity, inquiries, and resolutions
- Maintain compliance with HIPAA, PHI, and applicable program requirements
- Serve as a pharmacy subject matter resource
- Support new-hire training, continuing education, coaching, and development of pharmacy technician team members
- Monitor quality and operational trends
- Identify improvement opportunities
- Collaborate with supervisors and leadership to support service, productivity, and quality goals
Requirements
- Active Certified Pharmacy Technician credential (PTCB/CPhT, ExCPT, or equivalent) required
- Two (2) or more years of relevant pharmacy technician experience
- Experience preferably within managed care, health insurance, PBM, pharmacy benefits, or a related healthcare environment
- Experience with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider, or pharmacy support
- Experience training, coaching, mentoring, or serving as a subject matter resource preferred
- Strong communication, research, problem-solving, computer, and organizational skills
- Ability to navigate multiple systems and work effectively in a fast-paced remote environment
- Reside within the United States
- Reliable high-speed internet
- Professional, distraction-free home workspace
Core Competencies
Demonstrates expertise in pharmacy prior authorization processes, compliance with HIPAA and PHI regulations, and effective training and mentoring of pharmacy technicians. Strong problem-solving and communication skills are essential for resolving inquiries and improving operational quality.
Highest-signal resume keywords
- Certified Pharmacy Technician (PTCB/CPhT, ExCPT)
- Pharmacy Prior Authorizations
- Medication Terminology
- Training and Mentoring
- Compliance with HIPAA and PHI
ATS Optimization Keywords
Hard Skills
- Pharmacy Technician Experience
- Prescription Claims Processing
- Research and Problem-Solving
- Documentation of Authorization Activity
- Quality Monitoring
Soft Skills
- Strong Communication Skills
- Organizational Skills
Certifications & Qualifications
- Active Certified Pharmacy Technician Credential
Industry Keywords
- Managed Care
- Health Insurance
- Pharmacy Benefits
- Healthcare Environment
Tools & Technologies
- Multiple Systems Navigation
- Remote Work Tools