Pharmacy Prior Authorization Technician

Appalachian Mountain Health; Asheville (NC); On-site; USD 42,000 - 54,000; Full time

Job summary

Appalachian Mountain Health is seeking a Pharmaceutical Prior Authorization Technician to manage the PA process for medications and diagnostic imaging. The role involves using multiple portals, documenting in patient charts, and communicating outcomes to patients, providers, hospital scheduling, and pharmacies.

The ideal candidate has experience in pharmacy tech roles or similar, familiarity with PA portals, and strong organizational skills to handle urgent authorizations efficiently.

Qualifications

• Experience as a Pharmacy Technician, Medical Assistant, or Prior Auth Technician preferred.
• Experience with medical software is preferred.
• Experience with Microsoft Office (Excel and Word) is preferred.
• Background with exposure to Prior Authorizations is required.
• Prior knowledge of CPT codes preferred.

Responsibilities

• Fill out prior authorizations in Cover My Meds.
• Fill out prior authorization for Medicaid patients in NC Tracks.
• Utilize PA portals such as EviCore, Carelon, Evaility, Humana, RadMD and UHC.
• Contact patients for additional information when necessary.
• Follow up with providers on missing information for PA completion.
• Follow up with Insurance companies and document conversations.
• Read and interpret medical records to obtain information needed for PA.
• Close the loop on all Prior Authorizations and notify patients, providers and pharmacies.

Skills

Organized

Strong communication

Insurance eligibility knowledge

Meticulous documentation

Education

High School or GED equivalence

Tools

Cover My Meds

NC Tracks

EviCore

Carelon

Evaility

Humana

RadMD

UHC

Job description

Description

JOB SUMMARY

The Pharmaceutical Prior Authorization Technician will be responsible for the entire prior authorization (PA) process, once it is understood that a PA is required for both medications and diagnostic imaging. Utilizing sites numerous platforms to complete PA process, making notes in patient charts and following through with the approval and denial of said PA, along with notifying patient, providers, hospital scheduling departments, and pharmacies of the outcome of each prior authorization.

KEY ACCOUNTABILITIES

• Filling out prior authorizations in Cover My Meds
• Filling out prior authorization for Medicaid patients in NC Tracks
• Utilization of EviCore, Carelon, Evaility, Humana, RadMD and UHC as diagnostic imagine PA portals
• Contacting patients for additional information if necessary to complete the process
• Follow up with providers on missing information needed for the completion of each prior authorizations
• Follow up with Insurance companies and document conversations
• Reading and interpreting medical records to obtain the information necessary for prior authorization
• Closing the loop on all Prior Authorizations regardless of the outcome, which includes notifying patients, providers and pharmacies

Requirements

SKILLS

• Organized and self-motivated
• Strong oral and written communication skills to effectively interact with patients, physicians, insurances and support staff
• Able to discuss claims with insurance companies to verify insurance eligibility, benefits and requirements
• Meticulous documentation within medical charts regarding prior authorization status

ABILITIES

• Must possess a strong sense of urgency with filling out prior authorizations
• Partners well with Providers to problem solve denials of prior authorizations (if medical information is missing from the chart, the ability to discuss this with the provider to ensure appropriate information is updated in order to complete the process)
• Ability to navigate NC Tracks, Cover My meds, and diagnostic imaging portals.
• Ability to identify alternative medications/treatment/tests (if applicable) to previously denied prior authorizations requests

EXPERIENCE

• Background as a Pharmacy Technician, Medical Assistant or Prior Auth Technician (Referral Coordinator) is preferred
• High School or GED equivalence required
• Experience using medical software is preferred
• Experience with Microsoft office (Excel and Word) is preferred
• Background with exposure to Prior Authorizations is required
• Prior knowledge of CPT codes preferred
• Prior knowledge of Insurances is preferred