Pharmacy Preauthorization & Benefits Specialist

MetroHealth; Northern (KY); Hybrid; USD 45,000 - 60,000; Full time

Job summary

MetroHealth System is seeking a Pharmacy Technician to manage specialty pharmacy authorizations and patient assistance coordination. You'll process medication therapy requests and serve as the primary contact for benefits verifications and payor preauthorization, working with patients and program representatives.

You will follow up on authorizations, implement denial management, and help reduce drug expenses by guiding patients to manufacturer programs.

Qualifications

• Associate's Degree in Healthcare, Business Administration, or related field.
• Required experience: 1 year in hospital pharmacy or 2 years in retail pharmacy, or 2 years in hospital billing/reimbursement.
• Knowledge of reimbursement requirements and best practices.
• Strong communication, customer service, and analytical skills.
• Proficient in Microsoft Office (Excel/Word) and ability to work independently or in a team.

Responsibilities

• Process and obtain authorizations for medication therapy requests initiated by MetroHealth Clinicians for the Specialty Pharmacy.
• Serve as a primary contact for benefits verifications and payor preauthorization; liaise with patients and assistance programs.
• Follow up on authorizations and resolve issues; implement denial management protocols.
• Coordinate with pharmacy services, clinic physicians, Social Work, and patients on preauthorization and medical assistance programs.
• Ensure compliance with current Federal, State and other regulatory requirements; uphold MetroHealth standards.

Skills

Pharmacy terminology

Reimbursement knowledge

Microsoft Office (Excel, Word)

Communication skills

Customer service

Analytical thinking

Team collaboration

Independent work

Education

Associate's Degree in Healthcare or related field

PTCB certification (preferred)

Tools

EPIC

CoverMyMeds

Job description

MetroHealth System is seeking a Pharmacy Technician to manage specialty pharmacy authorizations and patient assistance coordination. You'll process medication therapy requests and serve as the primary contact for benefits verifications and payor preauthorization, working with patients and program representatives.

You will follow up on authorizations, implement denial management, and help reduce drug expenses by guiding patients to manufacturer programs.