Pharmacy Prior Authorization Technician

RX2 Solutions; Philadelphia (Philadelphia County); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a Pharmacy Prior Authorization Technician to support the authorization of pharmaceuticals. This role is critical in processing prior authorization requests, ensuring compliance with pharmacy guidelines, and maintaining productivity in a dynamic environment. The ideal candidate will have strong communication skills, attention to detail, and the ability to thrive in a fast-paced setting. Join a dedicated team where your contributions will enhance the quality of care and support vital healthcare processes.

Qualifications

• 1-3 years experience in PBM, managed care, or pharmacy preferred.
• Current PTCB or NCCT certification preferred.

Responsibilities

• Review and approve prior authorization requests based on criteria.
• Ensure timely and accurate data entry of authorization information.

Skills

Interpersonal Skills

Communication Skills

Attention to Detail

Typing Speed

Education

High School Diploma or GED

Job description

TITLE: Pharmacy Prior Authorization Technician
TYPE: Contract
LOCATION: Philadelphia, PA
ONSITE/REMOTE/HYBRID: Onsite
START DATE: May/June 2025
SHIFT: Day Shift, Monday through Friday, 8 hours/day

We are looking for a Pharmacy Prior Authorization Technician. Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Prior Authorization Technician plays a critical role in supporting the authorization of pharmaceuticals within a managed care environment. This position is primarily responsible for processing and evaluating prior authorization requests from physicians and members, ensuring all procedures align with established pharmacy guidelines and contractual obligations.

MAIN RESPONSIBILITIES

• Review and approve prior authorization and medical necessity requests based on established criteria.
• Interpret and apply clinical guidelines for prior authorization processing.
• Communicate professionally with internal departments and external stakeholders.
• Ensure timely and accurate data entry of prior authorization information into the system.
• Maintain productivity, accuracy, and timeliness across all job duties.
• Participate in internal audits and evaluations of service quality.
• Receive and process telephonic authorization requests, verifying information accuracy.
• Foster a respectful and cooperative team environment.
• Perform additional duties as assigned.
• Comply with HIPAA and company-specific procedures.
• Remain flexible and effective in a dynamic work environment.
• Support fraud prevention efforts by monitoring medication usage trends and reporting irregularities.
• Demonstrate strong communication and organizational skills.
• Attend annual mandatory training sessions.
• Possess working knowledge of both specialty and non-specialty pharmaceuticals.

QUALIFICATIONS

• High School Diploma or GED required.
• 1–3 years of experience in PBM, managed care, hospital, LTC, home infusion, or retail pharmacy preferred.
• Current PTCB or NCCT certification preferred.
• Typing speed of at least 35 words per minute.
• Strong interpersonal and communication skills.
• Demonstrated attention to detail and ability to follow protocols.
• Ability to thrive in a high-paced, evolving work setting.

EOE STATEMENT
We are an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law.