Pharmacy Precertification Specialist: Impactful Care

Methodist Le Bonheur Healthcare; Memphis (TN); On-site; USD 52,000 - 68,000; Full time

Job summary

Methodist Le Bonheur Healthcare in Memphis, TN is seeking a Pharmacy Technician to support precertification of eligible prescriptions and ensure documentation meets insurer guidelines for medical necessity and payment. You will review clinical information, coordinate with providers and insurers, and maintain accurate records to support timely authorization.

Requires 3–5 years in pharmacy settings, pharmacy technician credentials, and strong attention to detail.

Qualifications

• High School Diploma or Equivalent required.
• 3–5 years Pharmacy experience (clinical, hospital, outpatient, or specialty).
• Knowledge of prescription processing and insurer guidelines.

Responsibilities

• Responsible for precertification of eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity.
• Reviews clinical information submitted by medical providers to evaluate necessity and appropriateness of medication use.
• Assists with patient assistance and coordination for outpatient pharmacies from designated areas.
• Proactively analyzes information to make timely medical necessity review determinations and ensures accurate physician orders and CPT/HCPCS/ICD-10 codes for prior authorization.
• Contacts insurance companies to gather information and organize workflow for requested procedures.
• Maintains records and communications with physicians and offices to meet insurer reimbursement guidelines.
• Serves as a resource to Patient Access and Case Management regarding contract guidelines and precertification requirements.
• Performs research on denials or problematic accounts and suggests process improvements.

Skills

Pharmacy technician

Precertification

EMR documentation

Medical terminology

Attention to detail

Communication skills

Education

High School Diploma or Equivalent

Tools

EMR systems

Microsoft Word

Job description

Methodist Le Bonheur Healthcare in Memphis, TN is seeking a Pharmacy Technician to support precertification of eligible prescriptions and ensure documentation meets insurer guidelines for medical necessity and payment. You will review clinical information, coordinate with providers and insurers, and maintain accurate records to support timely authorization.

Requires 3–5 years in pharmacy settings, pharmacy technician credentials, and strong attention to detail.