Pharmacy Precertification Specialist (Medical Necessity)

Methodist Le Bonheur Healthcare; Memphis (TN); Hybrid; USD 40,000 - 60,000; Full time

Job summary

Methodist Le Bonheur Healthcare in Memphis seeks a Pharmacy Technician to handle precertification of eligible prescription medications for inpatient and outpatient services, ensuring documentation meets insurer guidelines. Responsibilities include reviewing clinical information, assisting with patient assistance and grant coordination, and coordinating with physicians for prior authorization.

You will analyze submitted information to support timely determinations, verify codes, and communicate

Qualifications

• High school diploma or equivalent required.
• Tennessee Pharmacy Technician license required.
• Certified Pharmacy Technician (PTCB) certification required.
• ExCPT certification preferred.
• Mississippi Pharmacy License preferred.

Responsibilities

• Precertification of eligible prescription medications for inpatient and outpatient services based on medical plan documents.
• Review clinical information to evaluate medical necessity and efficiency of prescription use.
• Assist with patient assistance and grant coordination for outpatient pharmacies.
• Analyze information to make timely medical necessity determinations; verify CPT/HCPCS/ICD-10 codes for prior authorization.
• Contact insurers and third-party admins to gather information and organize workflow.
• Collect, read, and interpret medical documentation for reimbursement and charge capture.
• Serve as primary contact with physicians to collect documentation and educate providers on pre-certification protocols.
• Communicate guidelines with Patient Access, Case Management, and others; research denials and suggest resolutions.

Skills

Pharmacy terminology

EMR documentation

Attention to detail

Communication skills

Problem solving

Microsoft Word

Education

High School Diploma or Equivalent

Tennessee Pharmacy Technician license

Certified Pharmacy Technician (PTCB)

ExCPT (preferred)

Mississippi Pharmacy License (preferred)

Tools

EMR systems

Microsoft Word

Job description

Methodist Le Bonheur Healthcare in Memphis seeks a Pharmacy Technician to handle precertification of eligible prescription medications for inpatient and outpatient services, ensuring documentation meets insurer guidelines. Responsibilities include reviewing clinical information, assisting with patient assistance and grant coordination, and coordinating with physicians for prior authorization.

You will analyze submitted information to support timely determinations, verify codes, and communicate