Pharmacy Access Pro: Prior Authorization Specialist

chaparralmedicalgroup; Ontario (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Chaparral Medical Group in California is seeking a Pharmacy Technician - Prior Authorization Specialist to manage medication prior authorization requests across clinics and coordinate with providers, patients, and insurers to ensure timely approvals.

The role requires analyzing clinical documentation, reviewing payer requirements, and maintaining compliant records in the EHR. A state-registered pharmacy technician with 1+ year of experience is preferred.

Qualifications

• High school diploma or equivalent required.
• Active Pharmacy Technician registration, license, or certification as required by state regulations.
• Minimum of one (1) year of experience as a Pharmacy Technician, healthcare authorization specialist, or related healthcare role.
• Experience processing medication prior authorizations and working with commercial, Medicare, and Medicaid insurance plans.
• Knowledge of pharmacy terminology, medication classifications, and insurance benefit structures.
• Experience utilizing electronic health records (EHR) and payer authorization portals.
• Strong organizational, analytical, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet established deadlines.
• Proficiency in Microsoft Office applications and healthcare tools.

Responsibilities

• Serve as the primary resource for medication prior authorization processes across all clinics.
• Manage a high-volume authorization workload while maintaining quality and accuracy standards.
• Review insurance eligibility, pharmacy benefits, and formulary requirements.
• Coordinate peer-to-peer review requests and appeal submissions when necessary.
• Maintain knowledge of payer-specific authorization requirements and medication coverage policies.
• Partner with providers and clinical leadership to improve authorization workflows and reduce delays in patient care.
• Monitor authorization metrics and contribute to process improvement initiatives.
• Provide exceptional customer service to patients by addressing medication access concerns and providing timely updates.
• Participate in department meetings, training programs, and organizational projects as assigned.
• Support compliance efforts by ensuring complete and accurate documentation of authorization activities.

Job description

Chaparral Medical Group in California is seeking a Pharmacy Technician - Prior Authorization Specialist to manage medication prior authorization requests across clinics and coordinate with providers, patients, and insurers to ensure timely approvals.

The role requires analyzing clinical documentation, reviewing payer requirements, and maintaining compliant records in the EHR. A state-registered pharmacy technician with 1+ year of experience is preferred.