Pharmacy Prior Authorization Technician - Specialty Medications

MaineHealth; Westbrook (ME); On-site; USD 30,000 - 40,000; Full time

Job summary

MaineHealth Corporate is seeking a Pharmacy Prior Authorization Technician to coordinate and process prior authorizations (PAs) for prescription medications. You will work with providers, pharmacists, payers, and patients using EHRs and payer portals to document and expedite PA submissions.

The role focuses on specialty medications initially, with potential expansion over time to adapt to changing clinic needs.

Qualifications

• High school diploma or equivalent.
• Active Pharmacy Technician license (CPhT required).
• One year of experience as a licensed pharmacy technician.

Responsibilities

• Review orders needing prior authorization.
• Initiate PA requests via electronic portals (e.g., CoverMyMeds, Surescripts, payer websites).
• Communicate with insurers to gather coverage requirements and status updates.
• Collaborate with providers and pharmacists for required clinical documentation.
• Document PA status in Epic using SmartPhrases and encounters.
• Notify providers of PA outcomes and assist with alternative medication strategies.
• Track and manage open prior authorizations to ensure timely resolution and refill coordination.
• Provide status updates to clinic staff and patients as allowed.
• Stay updated on payer formulary changes and authorization requirements.
• Participate in quality improvement and workflow optimization.

Skills

Pharmacy Technician

CPhT Certification

PA processing

EHR navigation

Education

High school diploma or equivalent

Tools

Epic

CoverMyMeds

Surescripts

Job description

MaineHealth Corporate

Professional - Clinical
Req #: 96191

Summary:

The Pharmacy Prior Authorization Technicianis 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 EHRand 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)

1. Education:High school diploma or equivalent required.
2. License/Certifications:Current or eligible for applicable state(s) license as a Pharmacy Technician. CPhT certification is required.
3. Experience:One year ofexperience 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 employmentwill depend onqualificationssuch asskills, relevant experience, education, certifications,and otherjob-relatedfactors. Thebase rangeis an estimate and does notreflect the full valueofourtotal compensationpackage.

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

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

In addition to base pay, MaineHealth offerscomprehensivebenefits, recognition programs, career growth opportunities, and,where applicable,shiftdifferentials or other incentives.

If you have questions about this role, please contact [e-mail]

Notice Regarding Maine Employer Surveillance Statute:

Pursuant to Maine's Employer Surveillance Statute, prospective care team members are notified that MaineHealth may monitor, collect, record, review, or retain information related to the use of its systems, networks, applications, files, data, communications platforms (including notified recordings), smart badges, building access, company vehicle GPS data, business calls, and workplace security cameras.

Information collected may be used for legitimate business purposes, including security, safety, compliance, investigations, training, quality assurance, and operational management.