Pharmacy Benefits Technician – Prior Authorization

The Health Plan Of West Virginia Inc; Wheeling (WV); On-site; USD 21,000 - 29,000; Full time

Job summary

The Health Plan Of West Virginia Inc is seeking a Pharmacy Technician in Wheeling, WV to handle member and provider inquiries, review drug coverage requests, and support clinical staff in coverage decisions. The role emphasizes accuracy, policy adherence, and timely processing.

Responsibilities include coordinating with Clinical Pharmacists, updating case notes, and communicating outcomes to providers and members, while ensuring compliance with plan policies and procedures.

Qualifications

• High school diploma or equivalent required.
• One year experience in a retail, hospital, managed care, or similar pharmacy setting.
• Typing speed 35 wpm minimum.
• Working knowledge of pharmacy systems and MS Excel.
• Knowledge of generic and trade names.
• Ability to follow established policies and procedures.
• Effective written and oral communication; strong organizational skills.

Responsibilities

• Handle medication coverage requests via prior authorization criteria.
• Coordinate with pharmacists/medical directors for clinical review when needed.
• Obtain information from providers to support coverage decisions.
• Attach policies to case documents for review.
• Update systems with coverage outcomes and communicate decisions.
• Research and respond to member/physician inquiries and grievances.

Skills

Typing 35 wpm

Communication skills

Organizational skills

Time management

Multitasking

Problem solving

Team player

Ability to follow procedures

Education

High School diploma or equivalent

Degree in health-related field

Tools

Pharmacy computer systems

Microsoft Excel

Job description

The Health Plan Of West Virginia Inc is seeking a Pharmacy Technician in Wheeling, WV to handle member and provider inquiries, review drug coverage requests, and support clinical staff in coverage decisions. The role emphasizes accuracy, policy adherence, and timely processing.

Responsibilities include coordinating with Clinical Pharmacists, updating case notes, and communicating outcomes to providers and members, while ensuring compliance with plan policies and procedures.