Pharmacy Precertification Specialist

Methodist Le Bonheur Healthcare; United States; On-site; USD 42,000 - 56,000; Full time

Job summary

Methodist Le Bonheur Healthcare in Memphis seeks a Pharmacy Technician to precertify prescription medications for inpatient and outpatient services, ensuring documentation meets insurer guidelines for medical necessity and payment.

The role involves reviewing clinical information, liaising with physicians and insurers, and maintaining accurate records to support reimbursement. Requires 3–5 years of pharmacy experience and active state licenses.

Qualifications

• High School Diploma or Equivalent.
• Pharmacy experience in clinical, hospital, outpatient, or specialty settings (3–5 years).
• Active pharmacy technician licenses (PTCB, state boards) preferred.

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 and appropriateness of medications.
• Assist with patient assistance and grant coordination for outpatient pharmacies.
• Determine CPT, HCPCS and ICD-10 codes for proper Prior Authorization.
• Contact insurers and third-party administrators to gather information and organize workflow for the requested procedures.
• Ensure medical documentation meets insurer guidelines for medical necessity and payment.

Skills

EMR usage

Medical terminology

Attention to detail

Communication skills

Education

Pharmacy Technician Certification Board (PTCB)

Tennessee Board of Pharmacy licensed

ExCPT - National Healthcareer Association

Mississippi Board of Pharmacy (preferred)

Tools

EMR systems

Microsoft Word

Job description

Methodist Le Bonheur Healthcare in Memphis seeks a Pharmacy Technician to precertify prescription medications for inpatient and outpatient services, ensuring documentation meets insurer guidelines for medical necessity and payment.

The role involves reviewing clinical information, liaising with physicians and insurers, and maintaining accurate records to support reimbursement. Requires 3–5 years of pharmacy experience and active state licenses.