Pharmacy Precertification Specialist

1200 MH-Memphis Hospitals; Indianapolis (IN); On-site; USD 27,552 - 35,817; Full time

Job summary

Methodist Le Bonheur (MLH) is seeking a Pharmacy Technician to precertify eligible prescription medications for inpatient and outpatient services. You will verify orders, coordinate with insurers, and ensure documentation meets medical necessity and payment guidelines.

The role involves working with physicians to obtain required documentation, educating providers on protocols, and supporting deny-reduction efforts across departments.

Qualifications

• High School Diploma or equivalent.
• 3–5 years of pharmacy experience (clinical, hospital, outpatient, or specialty).
• Licensed/certified Pharmacy Technician credentials listed in Education.

Responsibilities

• Precertify eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity.
• Review clinical information submitted by providers to evaluate necessity, appropriateness, and efficiency of prescription use.
• Verify physician orders and determine CPT, HCPCS, and ICD‑10 codes for prior authorization.
• Contact insurance companies and third‑party administrators to gather information and coordinate workflow.
• Collect, read, and interpret medical documentation to ensure compliance with insurer reimbursement guidelines and proper charge capture.
• Act as primary contact with physicians/physician offices to obtain required documentation.
• Educate providers on pre‑certification protocols and maintain ongoing rapport.
• Communicate information to Patient Access, Case Management, and other internal stakeholders regarding contract guidelines and requirements.
• Research denials or problematic accounts, identify trends, and recommend process improvements.

Skills

Prescription processing

EMRs

Medical terminology

Attention to detail

Communication

Problem solving

Microsoft Word

Education

High School Diploma

Pharmacy Technician – Tennessee Board of Pharmacy

Certified Pharmacy Technician – PTCB

ExCPT (NHA)

Pharmacy Technician – Mississippi Board of Pharmacy

Tools

EMRs

Microsoft Word

Healthcare information systems

Job description

Methodist Le Bonheur (MLH) is seeking a Pharmacy Technician to precertify eligible prescription medications for inpatient and outpatient services. You will verify orders, coordinate with insurers, and ensure documentation meets medical necessity and payment guidelines.

The role involves working with physicians to obtain required documentation, educating providers on protocols, and supporting deny-reduction efforts across departments.