Pharmacy Prior Authorization Technician

TalentBurst; Philadelphia (Philadelphia County); On-site; USD 40,000 - 65,000; Full time

Job summary

Join a forward-thinking staffing provider as a Pharmacy Prior Authorization Technician in Philadelphia. In this role, you will assist with the prior authorization process, ensuring compliance with pharmacy guidelines while maintaining high productivity and quality. Your expertise in pharmacy practices will be essential in reviewing requests and supporting a diverse team. This is an excellent opportunity to grow in a fast-paced environment while contributing to the healthcare sector. If you are passionate about making a difference and thrive in a collaborative setting, this role could be the perfect fit for you.

Qualifications

• 1-3 years of experience in pharmacy settings preferred.
• Current PTCB or NCCT Certification is a plus.

Responsibilities

• Assist in the prior authorization process and handle inquiries.
• Maintain productivity and comply with HIPAA and company policies.

Skills

Experience in PBM or managed care

Typing speed of 35 words per minute

PTCB or NCCT Certification

Education

High School Diploma / GED

Job description

Pharmacy Prior Authorization Technician
Philadelphia, PA
13 weeks

Skills:

• One to Three years of experience in PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, or retail pharmacy (preferred).
• Minimum typing speed of 35 words per minute.
• Current PTCB or NCCT Certification (preferred).

Education:

High School Diploma / GED

Under the supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician I:

1. Assists in the prior authorization process.
2. Reviews and approves physician or member inquiries for pre-authorization and medical necessity requests based on pharmacy guidelines and contract criteria.
3. Enters data accurately and timely into the prior authorization system to meet client requirements.
4. Applies clinical criteria for processing requests promptly.
5. Handles incoming requests via telephone, verifying information across multiple systems.
6. Supports Fraud and Abuse program by reviewing medication utilization records, reporting suspected fraud, and advising providers on patterns outside guidelines.
7. Maintains productivity, quality, and timeliness in job responsibilities.
8. Participates in departmental self-audits for service evaluation.
9. Fosters teamwork, respect, and diversity; maintains professional communication with internal and external partners.
10. Complies with HIPAA and company policies.
11. Adapts to a fast-paced, changing environment.
12. Demonstrates strong interpersonal, written, and oral communication skills.
13. Attends annual training sessions.
14. Possesses strong knowledge of specialty and non-specialty pharmaceuticals.
15. Performs additional duties as assigned.

About the company

Founded in 2002, TalentBurst is a leading staffing provider supporting large MSP contingent workforce programs with delivery centers in Boston, San Francisco, Miami, and Gurgaon, India, serving 90 Fortune 500 clients weekly.