Pharmacy Prior Authorization Technician - Specialty Medications

MaineHealth; United States; Remote; USD 30,000 - 40,000; Full time

Benefits offered by this job

Paid parental leave

Flexible work options

Student loan assistance

Professional development opportunities

Well-being resources

Job summary

The Pharmacy Prior Authorization Technician at MaineHealth coordinates and processes prior authorizations (PAs) for prescription medications, using the EHR and payer portals to facilitate timely access. This role supports the clinical team by reducing delays in specialty medications and communicating PA outcomes to providers.

Initially focusing on Specialty Medications in specific clinics, the position leverages CoverMyMeds/Surescripts, Epic, and payer interactions to collect required

Qualifications

• High school diploma or equivalent required.
• Current or eligible for state Pharmacy Technician license; CPhT certification required.
• One year of experience as a licensed pharmacy technician.

Responsibilities

• Review medication orders needing prior authorization, especially specialty meds.
• Initiate and complete prior authorization requests through electronic portals.
• Communicate with insurance companies for coverage requirements and status updates.
• Collaborate with providers and pharmacists to obtain necessary clinical documentation.
• Document PA status, approvals, denials, and follow-ups in Epic.
• Notify providers of PA outcomes and assist with alternative medication strategies.
• Track and manage open PAs to ensure timely resolution and refill coordination.
• Provide status updates or coverage information to clinic staff and patients.
• Maintain knowledge of payer formulary changes and authorization requirements.
• Engage in quality improvement and workflow optimization efforts.

Skills

Prior authorization coordination

Epic EHR usage

Payer portal navigation

Education

High school diploma or equivalent

Pharmacy Technician license (CPhT certification required)

Tools

Epic EHR

CoverMyMeds

Surescripts

Job description

Remote

Summary

The Pharmacy Prior Authorization Technician is responsible for coordinating and processing prior authorizations (PAs) for prescription medications to ensure timely patient access to treatment. Working closely with providers, pharmacists, payers, and patients, the technician utilizes the EHR and payer portals to facilitate and document the PA process.

This role is key to supporting the clinical team in minimizing treatment delays and improving medication access. The role will initially focus on Specialty Medications in specific clinics but is expected to expand and change over time.

Key Responsibilities

• Review medication orders (especially specialty medications) needing prior authorization.
• Initiate and complete prior authorization requests through electronic portals (e.g., CoverMyMeds, Surescripts, payer websites).
• Communicate with insurance companies to gather coverage requirements and status updates.
• Collaborate with providers and pharmacists to obtain necessary clinical documentation for PA submissions.
• Document PA status, approvals, denials, and follow-ups within Epic using SmartPhrases and encounters.
• Notify providers of PA outcomes and assist with alternative medication strategies when necessary.
• Track and manage open prior authorizations to ensure timely resolution and refill coordination.
• Support clinic staff and patients by providing status updates or coverage information as allowed.
• Maintain up-to-date knowledge of payer formulary changes and authorization requirements.
• Participate in continuous quality improvement and workflow optimization efforts.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

• Education: High school diploma or equivalent required.
• License/Certifications: Current or eligible for applicable state(s) license as a Pharmacy Technician. CPhT certification is required.
• Experience: One year of experience as a licensed pharmacy technician.

Additional Information

MaineHealth is committed to fostering a supportive, inclusive environment where care team members can thrive while making a meaningful impact in the communities we serve across Maine and New Hampshire. We offer competitive benefits including paid parental leave, flexible work options, student loan assistance, professional development opportunities, and well-being resources-so you can grow your career while feeling supported both personally and professionally.

We recognize the value each team member brings to our organization. Any offer of employment will depend on qualifications such as skills, relevant experience, education, certifications, and other job-related factors. The base range is an estimate and does not reflect the full value of our total compensation package.

The pay range for this position is $21.97 to $29.28 per hour.

Compensation for part-time positions is determined on a prorated basis consistent with the scheduled hours and applicable full-time equivalent (FTE).