Impactful Pharmacy Precertification Specialist

1200 MH-Memphis Hospitals; Indianapolis (IN); On-site; USD 60,000 - 75,000; Full time

Job summary

Methodist Le Bonheur is seeking a Pharmacy Technician to manage precertification of inpatient and outpatient prescription medications, ensuring documentation meets insurer medical necessity and payment guidelines.

You will review clinical information, determine codes for prior authorization, and coordinate with physicians and insurers to support timely approvals and proper reimbursement.

Qualifications

• High School Diploma or Equivalent required.
• Pharmacy experience (clinical, hospital, outpatient, or specialty) 3–5 years.
• Pharmacy Technician license ( Tennessee ) and Pharmacy Technician Certification Board.
• ExCPT and Mississippi Board license preferred (optional).

Responsibilities

• Responsible for precertification of eligible prescription medications for inpatient and outpatient services.
• Ensure documentation meets insurer guidelines for medical necessity and payment.
• Review clinical information to evaluate necessity, appropriateness and efficiency of medications.
• Contacts insurance companies to gather information and organize workflow.
• Determine CPT, HCPCS and ICD-10 codes for proper Prior Authorization.
• Maintain rapport with providers and educate them on pre-certification protocols.

Skills

EMR documentation

Medical terminology

Attention to detail

Verbal communication

Written communication

Critical thinking

Pharmacy terminology

Microsoft Word

Education

High School Diploma or Equivalent

Tools

EMR systems

Microsoft Word

Job description

Methodist Le Bonheur is seeking a Pharmacy Technician to manage precertification of inpatient and outpatient prescription medications, ensuring documentation meets insurer medical necessity and payment guidelines.

You will review clinical information, determine codes for prior authorization, and coordinate with physicians and insurers to support timely approvals and proper reimbursement.