Pharmacy Tech III Prior Auth

NKC Health; Kansas City, Northern (MO, KY); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Life, FSA

Competitive wages

Paid time off

Six paid holidays per year

Educational assistance

Day shift schedules

Job summary

NKC Health is seeking a Pharmacy Tech III (Prior Auth) to join the Headache Center team in the Northland. The role supports clinic-based prior authorizations, enhances patient care, and improves adherence and outcomes through efficient processing.

The technician may perform all required tasks within the pharmacy department under supervision, ensuring compliance with applicable laws and regulations.

Qualifications

• CPhT certification and PTCB credential required.
• Minimum three years of experience in healthcare or related field.
• Two years of experience with managed care insurers and/or Medicare/Medicaid.
• Two years of experience with pharmacy benefit prior authorization and specialty pharmacy processes.

Responsibilities

• Schedule patients by receiving referrals and screening demographics; perform benefits investigation and document prior authorizations.
• Provide information on processing prior authorizations; contact payers and obtain approvals that meet criteria; outline review timelines.
• Verify benefit information before appointments to prevent revenue loss and ensure smooth claims processing.
• Coordinate processing, distribution, and delivery of referrals; manage inventory of specialty medications; follow up with patients to ensure receipt and billing for services.
• Identify co-pay assistance programs and act as liaison for manufacturer-funded assistance; identify eligible participants.
• Other duties as assigned.
• Compliance with laws and regulations.

Skills

CPhT

PTCB

Managed care experience

Prior authorization

Pharmacy benefit management

Customer service

Education

High School Diploma or GED

Associates Degree preferred

Job description

Summary

NKC Health is hiring a Pharmacy Tech III (Prior Auth) to join our Headache Center team in the Northland! If you’re looking for a great opportunity to serve our community and be part of a growing organization, join our NKC Health team!

Reasons to Join NKC Health:

• Comprehensive Benefits (Medical, Dental, Vision, Life, FSA)
• Competitive wages
• Paid time off for personal/vacation/sick
• Six paid holidays per year
• Educational assistance
• Day shift schedules

Job Description:

As an integral member of the pharmacy team and under the supervision of a pharmacist, the prior authorization pharmacy technician is responsible for providing clinic-based prior authorization support and improving patient care fragmentation, so patientscan obtain their medication timely. These efforts lead to increased patient adherence and satisfaction which subsequently result in an improved quality of life as well as patient outcomes. The position allows for a workload shift to an appropriate skill mix improving provider, nursing, and office staff satisfaction as more time is available for direct patient care related activities. The individual will also perform all required technical functions within the pharmacy department to assist in providing quality pharmaceutical care to patients as needed. The prior authorization technician may provide services within the scope of their license, certification, registration, and/or assessed competencies. Practice will be in accordance with laws and regulations.

Job Duties:

• Conduct patient scheduling process by receiving referrals, screening patient demographic information, conducting benefits investigation, and determining payer coverage. Documents formal notes in the electronic medical record where appropriate, documenting the findings of the prior authorizations.
• Provide specialized information on a variety of matters relating to the processing of prior authorizations. Contact payers and obtain prior authorizations that meet payer criteria for access. As necessary, outline how long it will take to review and approve/deny the priorauthorization. Ensure insurance coverage requests are submitted along with all necessary documentation. Prospectively completere‑authorization of expiring prior authorizations for patients that will be continuing therapy.
• Validate benefit information before a patient arrives for an appointment and verify details thoroughly to ensure a comprehensive claimsprocess that helps prevent revenue loss and enhances fiscal stability.
• Coordinate the processing, distribution, and delivery of referrals while maintaining product integrity, managing inventory of specialty medications, following up with patients to ensure that they receive medications, and billing for services rendered.
• Identify co‑pay assistance for medications including manufacturer co‑pay cards or foundation assistance. Act as a liaison for manufacturer provided medication assistance programs for healthcare staff and patients. Identifies all qualified medication assistance program participants in accordance with eligibility requirements.
• Other duties as assigned.
• Practice will be in accordance with laws and regulations.

Minimum Qualifications:

• Required: Minimum three (3) years of experience in healthcare or related field.
• Preferred: Two (2) years of experience working with managed care insurance companies and/or Medicare/Medicaid.
• Two (2) years of experience working with medical, and pharmacy benefit prior authorization process.
• Two (2) years of experience working with manufacturers provided free drug programs.
• Two (2) years of experience working with specialty pharmacy processes.
• Maintain technician licensure and credentials in good standing and maintain continuing education credits as required by Missouri Board of Pharmacy & Pharmacy Technician Certification Board, and any other regulatory agencies.
• Required: CPhT (Certified Pharmacy Technician), PTCB (Pharmacy Technician Certification Board)
• High School Diploma or GED equivalent required, Associates Degree in a related field preferred

More Possibilities:

As the largest network of providers in the Northland, we can offer you more opportunities to grow. Here at NKC Health, we believe that together, we will become legendary for our commitment to remarkable patient care. If you are looking to better the lives of those in our community, then join our NKC Health family, where your voice counts.

NKC Healthis an Equal Opportunity Employer and values diversity in our organization. We do not discriminate against any applicant for employment or employee on the basis of race, color, religion, gender, age, marital status, sexual orientation, national origin, disability, veteran status or any other classification protected by applicable discrimination laws.