Pharmacy Prior Authorization Specialist

CDPHP in; Buffalo (NY); On-site; USD 29,000 - 46,000; Full time

Benefits offered by this job

Health and dental insurance

Retirement plan

Wellness program

Paid time off

Paid holidays

Job summary

CDPHP in Buffalo, NY is seeking a Pharmacy Prior Authorization Technician (Finance) to support managed care pharmacy operations under a licensed pharmacist. You will handle live calls with members, physicians, and pharmacists, provide information on benefits, formulary coverage, and CDPHP initiatives, and assist with prior authorization work using approved algorithms.

The role emphasizes data entry, real-time authorization, and collaboration to resolve issues related to mail-order and specialty

Qualifications

• High school diploma or equivalent required; associates preferred.
• CPhT certification or nursing/MA background preferred.
• Proficient in Microsoft Office and basic medical terminology.

Responsibilities

• Review medical exception requests based on pharmacist-created algorithms.
• Assess documentation against criteria for prior authorization approvals.
• Assist with data entry and monitor member profiles for PA requests and ad hoc reports.
• Provide information by phone to physicians and pharmacists regarding pharmacy initiatives.
• Provide real-time authorization for prescription medications (vacation supplies, duplicates, therapy overrides).
• Implement formulary tools (PA, quantity limits, step therapy, dose optimization).
• Collaborate with internal/external customers to resolve system issues related to pharmacy benefits.
• Research and resolve issues around mail-order, specialty pharmacy, or claims in the Facets system.
• Back up Pharmacy Benefits Team phone queue as needed for internal/external inquiries.
• Monitor PBM interfaces for eligibility, claims, formulary; conduct testing as needed.
• Support quality improvement and help establish productivity/quality standards.
• Attend staff meetings and in-service trainings as requested.
• Perform rotating on-call responsibilities including holidays/evenings.
• Work additional hours to meet turnaround times.

Skills

Strong communication

Customer service

Problem solving

Attention to detail

Microsoft Office

Education

High school diploma

Associates degree preferred

CPhT certification preferred

LPN/Medical Assistant background preferred

Tools

Facets system

Job description

CDPHP in Buffalo, NY is seeking a Pharmacy Prior Authorization Technician (Finance) to support managed care pharmacy operations under a licensed pharmacist. You will handle live calls with members, physicians, and pharmacists, provide information on benefits, formulary coverage, and CDPHP initiatives, and assist with prior authorization work using approved algorithms.

The role emphasizes data entry, real-time authorization, and collaboration to resolve issues related to mail-order and specialty