Pharmacy Technician

chaparralmedicalgroup; Ontario (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Chaparral Medical Group in California is seeking a Pharmacy Technician - Prior Authorization Specialist to manage medication prior authorization requests across clinics and coordinate with providers, patients, and insurers to ensure timely approvals.

The role requires analyzing clinical documentation, reviewing payer requirements, and maintaining compliant records in the EHR. A state-registered pharmacy technician with 1+ year of experience is preferred.

Qualifications

• High school diploma or equivalent required.
• Active Pharmacy Technician registration, license, or certification as required by state regulations.
• Minimum of one (1) year of experience as a Pharmacy Technician, healthcare authorization specialist, or related healthcare role.
• Experience processing medication prior authorizations and working with commercial, Medicare, and Medicaid insurance plans.
• Knowledge of pharmacy terminology, medication classifications, and insurance benefit structures.
• Experience utilizing electronic health records (EHR) and payer authorization portals.
• Strong organizational, analytical, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet established deadlines.
• Proficiency in Microsoft Office applications and healthcare tools.

Responsibilities

• Serve as the primary resource for medication prior authorization processes across all clinics.
• Manage a high-volume authorization workload while maintaining quality and accuracy standards.
• Review insurance eligibility, pharmacy benefits, and formulary requirements.
• Coordinate peer-to-peer review requests and appeal submissions when necessary.
• Maintain knowledge of payer-specific authorization requirements and medication coverage policies.
• Partner with providers and clinical leadership to improve authorization workflows and reduce delays in patient care.
• Monitor authorization metrics and contribute to process improvement initiatives.
• Provide exceptional customer service to patients by addressing medication access concerns and providing timely updates.
• Participate in department meetings, training programs, and organizational projects as assigned.
• Support compliance efforts by ensuring complete and accurate documentation of authorization activities.

Job description

Company Overview

Over the past 40 years, Chaparral Medical Group (CMG) has established itself as a leading primary and multi-specialty care provider for California's Inland Empire. In 2022, CMG joined forces with Akido Labs , a tech-enabled healthcare company, to transform the healthcare experience from the ground up. This partnership joins CMG's medical services with Akido's innovative technology to relieve the frustrations felt by everyone involved in care delivery, from medical providers and their staff, to the patients and their families. Ultimately, this means our providers spend more time caring for patients and less time bogged down with administrative work.

As part of the Akido medical network, we are currently responsible for more than 250,000 patients in Southern California, with plans to expand into new markets across the U.S. We care deeply about the communities we serve and are committed to providing accessible, high quality healthcare that helps our patients and communities live their fullest lives. We're building a dynamic, diverse and driven team as we continue to grow and broaden our impact. We are seeking passionate people who care deeply about helping patients and communities. We hope you'll join our team

Position Summary

The Pharmacy Technician - Prior Authorization Specialist is responsible for managing and coordinating medication prior authorization requests across all clinics within the organization. This role serves as a critical liaison between providers, patients, pharmacies, insurance carriers, and clinical staff to ensure timely approval of prescribed medications and continuity of care. The Pharmacy Technician will review authorization requirements, gather necessary clinical documentation, submit requests, monitor pending cases, and communicate outcomes to key stakeholders. Success in this role requires strong attention to detail, knowledge of pharmacy benefit management processes, excellent communication skills, and the ability to work efficiently in a fast-paced healthcare environment.

Essential Functions

• Process medication prior authorization requests for all clinic locations in accordance with payer requirements and organizational standards.
• Review patient charts and clinical documentation to ensure completeness prior to submission.
• Collaborate with providers, medical assistants, nurses, and clinic staff to obtain supporting clinical information.
• Submit prior authorization requests through payer portals, electronic prior authorization systems, fax, or phone.
• Monitor authorization status and follow up with insurance companies to expedite approvals.
• Communicate authorization determinations, denials, and appeals requirements to providers and clinic teams.
• Maintain accurate documentation of all authorization activities within the electronic health record (EHR).
• Track authorization turnaround times and identify barriers impacting medication access.
• Assist in resolving medication coverage issues and identify alternative formulary options when appropriate.
• Ensure compliance with regulatory requirements, insurer guidelines, and organizational policies.

Key Responsibilities

• Serve as the primary resource for medication prior authorization processes across all clinics.
• Manage a high-volume authorization workload while maintaining quality and accuracy standards.
• Review insurance eligibility, pharmacy benefits, and formulary requirements.
• Coordinate peer-to-peer review requests and appeal submissions when necessary.
• Maintain knowledge of payer-specific authorization requirements and medication coverage policies.
• Partner with providers and clinical leadership to improve authorization workflows and reduce delays in patient care.
• Monitor authorization metrics and contribute to process improvement initiatives.
• Provide exceptional customer service to patients by addressing medication access concerns and providing timely updates.
• Participate in department meetings, training programs, and organizational projects as assigned.
• Support compliance efforts by ensuring complete and accurate documentation of authorization activities.

Required Qualifications

• High school diploma or equivalent required.
• Active Pharmacy Technician registration, license, or certification as required by state regulations.
• Minimum of one (1) year of experience as a Pharmacy Technician, healthcare authorization specialist, or related healthcare role.
• Experience processing medication prior authorizations and working with commercial, Medicare, and Medicaid insurance plans.
• Knowledge of pharmacy terminology, medication classifications, and insurance benefit structures.
• Experience utilizing electronic health records (EHR) and payer authorization portals.
• Strong organizational, analytical, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet established deadlines.
• Proficiency in Microsoft Office applications and healthcare t