Pharmacy Patient Advocate

Jobtailor; Mesa (AZ); On-site; USD 42,000 - 54,000; Full time

Job summary

Jobtailor in Mesa, AZ seeks a Pharmacy Technician to support the Pharmacy Department in processing and finalising prior authorization requests. You will apply approved guidelines for clinical decisions, help ensure claims adjudication accuracy, and communicate with healthcare professionals.

Requirements include a Pharmacy Technician Certification and state licensure where applicable, plus 3+ years of managed care experience.

Qualifications

• Pharmacy Technician Certification is required.
• 3+ years of pharmacy technician experience with managed care emphasis.
• Licensure in the state of practice where applicable.

Responsibilities

• Process pharmacy prior authorization requests accurately and timely.
• Perform clinical decision making using approved guidelines for pharmacy issues.
• Finalise PA requests under supervision of a pharmacist/medical director.
• Ensure pharmacy claims adjudicate correctly and provide reports as needed.
• Communicate clearly with healthcare professionals.
• Provide reporting for internal and external customers.

Skills

PA processing

Pharmacy claims analysis

Clinical decision making

Communication

Education

Pharmacy Technician Certification

State licensure (where applicable)

Tools

Pharmacy software

Job description

Job Responsibilities

• Supports the Pharmacy Department in processing pharmacy prior authorization (PA) requests in an accurate and timely manner
• Performs clinical decision making using approved guidelines while addressing issues pertaining to pharmacy
• Processes and finalizes PA requests based on approved guidelines under the supervision of a pharmacist and/or medical director
• Assures that pharmacy claims are adjudicating correctly
• Communicates clearly and accurately with other healthcare professionals
• Provides reporting for internal and external customers including pharmacy claims analysis
• Participates in the daily review of the Medicare denied claims report
• Meets established departmental performance metrics for quality and productivity

Requirements

• Requires pharmacy technician licensure in the state of practice (where applicable)
• Pharmacy technician certification required
• 3 or more years of experience performing pharmacy technician duties in a pharmacy setting with managed care emphasis preferably within a healthcare organization or retail pharmacy
• Good written and verbal communication skills for interfacing with all levels of staff, physicians, patients and other contacts
• Ability to learn and master various software programs necessary for job functions

Core Competencies

Demonstrates expertise in processing pharmacy prior authorization requests and clinical decision‑making in accordance with approved guidelines. Proficient in pharmacy claims analysis and effective communication with healthcare professionals.

Hard Skills

• Processing Pharmacy Prior Authorization Requests
• Finalizing PA Requests
• Adjudicating Pharmacy Claims
• Reporting for Internal and External Customers
• Daily Review of Medicare Denied Claims

Soft Skills

• Good Written Communication Skills
• Good Verbal Communication Skills

Certifications & Qualifications

• Pharmacy Technician Certification

Industry Keywords

• Healthcare Organization
• Retail Pharmacy
• Managed Care

Tools & Technologies

• Various Software Programs