Pharmacy Prior Authorization Specialist

MetroPlus; New York, Northern (NY, KY); Hybrid; USD 42,000 - 63,000; Full time

Job summary

MetroPlus Health in New York is seeking a Prior Authorization Review Technician to input, review, and notify on prior authorization requests within the pharmacy workflow. You will handle overrides in the adjudication system, respond to member inquiries, and support quality improvement initiatives.

The role requires an Associate's degree and 3 years as Pharmacy Technician, with strong Microsoft Word/Excel skills and PTCB or ExCPT certification. This is a hybrid role with standard daytime shifts.

Qualifications

• Associate's degree and 3 years of Pharmacy Technician experience required, bachelor's preferred.
• Experience with government programs (Medicare/Medicaid) preferred.
• Pharmacy Technician Certification (PTCB or ExCPT) required.

Responsibilities

• Inputs all received medical and pharmacy benefit prior authorization requests into processing platforms with accurate transcription.
• Reviews selected prior authorization requests and provides recommendations per guidelines.
• Answers inquiries from members, providers, pharmacies, and stakeholders via call center.
• Notifies priorities and enters medication overrides into the pharmacy adjudication platform accurately.
• Performs audits of vendor-entered medication overrides in the adjudication platform.
• Assists with pharmacy case management and supports quality improvement initiatives.
• Responds to triaged inquiries related to MetroPlusHealth pharmacy and medical benefits.

Skills

Auditing skills

Communication skills

Teamwork

Microsoft Word

Microsoft Excel

PowerPoint

Microsoft Access

Education

Associate's degree + 3 years Pharmacy Technician experience

Bachelor's degree preferred

HS diploma + 5 years Pharmacy Technician experience

Tools

Pharmacy adjudication systems

Job description

MetroPlus Health in New York is seeking a Prior Authorization Review Technician to input, review, and notify on prior authorization requests within the pharmacy workflow. You will handle overrides in the adjudication system, respond to member inquiries, and support quality improvement initiatives.

The role requires an Associate's degree and 3 years as Pharmacy Technician, with strong Microsoft Word/Excel skills and PTCB or ExCPT certification. This is a hybrid role with standard daytime shifts.