Pharmacy Authorization Specialist (Injectables)

Universal Health Services; Reno (NV); On-site; USD 52,000 - 78,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive compensation

Excellent Medical, Dental, Vision and

401(K) with company match

Job summary

Prominence Health is seeking a Pharmacy Authorization Specialist (Pharmacy Technician) to coordinate prior authorizations for injectable drugs between the health plan, members, and providers. You will verify diagnoses, billing codes, and dosages to ensure proper coverage decisions are made efficiently.

The role requires understanding of medical drug billing, input of clinic notes, and effective provider outreach to gather documentation, ultimately improving workflow and member satisfaction

Qualifications

• High School diploma or equivalent
• Current and valid state licensure as a pharmacy technician is required
• 3+ years in hospital or retail pharmacy is preferred
• Ability to communicate in English, both verbally and in writing
• Knowledge of medical terminology
• Exceptional customer service skills when interfacing between the health plan and providers
• Understanding of the medical drug billing process
• Proficient in Microsoft Office
• Enjoys working in both individual and team settings
• Comfortable calculating doses and frequencies for medication regimens
• Self-starter, resourceful and able to execute projects in a fast-paced environment
• Strong analytical skills
• Knowledge of prior authorizations processes
• Attention to detail and accuracy
• Ability to use multiple software programs
• Understanding of health plan departments and problem resolution
• Comfortable collecting and tracking performance metrics and reports

Responsibilities

• Coordinate the prior authorization review process between Prominence Health Plan, members, and providers
• Prepare and load prior authorizations for injectable drugs with accurate diagnosis and billing codes
• Verify dose and frequency of submitted requests for accuracy
• Perform provider outreach to obtain documentation for coverage determinations as needed

Skills

Exceptional customer service

Knowledge of medical terminology

Microsoft Office

Analytical skills

Dose calculation

Drug billing knowledge

Teamwork

Communication skills

Education

Current and valid state licensure as a pharmacy technician

High School diploma or equivalent

Job description

Prominence Health is seeking a Pharmacy Authorization Specialist (Pharmacy Technician) to coordinate prior authorizations for injectable drugs between the health plan, members, and providers. You will verify diagnoses, billing codes, and dosages to ensure proper coverage decisions are made efficiently.

The role requires understanding of medical drug billing, input of clinic notes, and effective provider outreach to gather documentation, ultimately improving workflow and member satisfaction