Pharmacy Technician - Prior Authorizations

SCAN Health Plan; Long Beach (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a dynamic not-for-profit organization dedicated to enhancing the lives of older adults. As a Prior Authorization Pharmacy Technician, you'll be pivotal in streamlining the medication approval process, ensuring timely access to prescriptions while collaborating with healthcare providers and pharmacies. This role not only allows you to leverage your analytical and communication skills but also offers the chance to make a significant impact on patient care. With a focus on continuous improvement, you'll help optimize workflows and enhance patient outcomes. Embrace this opportunity to be part of a mission-driven team that values your contributions and fosters a supportive work environment.

Benefits

Annual employee bonus program

Robust Wellness Program

Generous paid-time-off (PTO)

Eleven paid holidays per year

401(k) Retirement Saving Plan with employer match

Employee recognition program

Tuition reimbursement

Qualifications

• 5+ years in managed care, focusing on prior authorization and pharmacy benefit management.
• Pharmacy Technician License for California preferred.

Responsibilities

• Evaluate and process prior authorization requests for medications.
• Coordinate with healthcare providers and manage PA documentation.

Skills

Analytical Skills

Problem Solving

Communication Skills

Organizational Skills

Interpersonal Skills

Education

High School Diploma

Bachelor's Degree

Tools

Microsoft Office 2016

SQL

Tableau

PBM Systems

Job description

Pharmacy Technician - Prior Authorizations

Job Category: Medical Management

Requisition Number: PHARM006881

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• Posted: February 12, 2025
• Full-Time

Locations

Long Beach, CA 90806, USA

Description

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas, and New Mexico.

The Job

The Prior Authorization Pharmacy Technician will play a key role in supporting the prior authorization (PA) process for prescription medications. This individual will collaborate with healthcare providers, pharmacies, and insurance companies to ensure timely approval of medications, minimize delays in patient care, and promote efficient use of healthcare resources.

You Will

1. Review and Process Prior Authorizations: Evaluate and process PA requests for prescription medications based on clinical guidelines and insurance policies.
2. Coordinate with Providers and Pharmacists: Communicate with healthcare providers to gather necessary clinical information and ensure documentation meets PA requirements.
3. Utilization of Pharmacy Benefit Management (PBM) Systems: Input, track, and manage prior authorization requests using PBM systems and other managed care platforms.
4. Adherence to Regulatory Guidelines: Ensure compliance with federal and state regulations, insurance policies, and organizational procedures when processing prior authorization requests.
5. Documentation and Reporting: Maintain accurate and up-to-date records of all PA activities, including approvals, denials, and follow-up requests.
6. Customer Service: Respond to inquiries from patients, providers, and internal teams regarding the status of PA requests and related processes.
7. Continuous Improvement: Assist in identifying opportunities for improving prior authorization workflows and patient outcomes.
8. Educate Providers: Provide information to physicians and healthcare teams regarding formulary changes, clinical alternatives, and PA criteria as needed.
9. All other duties as assigned.

Your Qualifications

1. High School Diploma or equivalent experience. Bachelor's Degree preferred.
2. Pharmacy Technician License for the State of California is preferred.
3. Minimum 5 years of experience in a managed care setting, specifically focused on prior authorization and pharmacy benefit management.
4. Experience with file management and working with different file formats (e.g. text files).
5. Regulatory audit experience.
6. Experience managing small projects from inception through completion.
7. Claims adjudication experience is preferred.
8. Experience with analyzing and trending claims data.
9. Technical expertise - Advanced analytical skills.
10. Problem Solving - Basic problem-solving skills.
11. Communication - Good communication and interpersonal skills.
12. Expert knowledge of CMS Medicare Part B and D benefits, rules, and regulations.
13. PDE knowledge of error resolution and calculations.
14. Excellent grammar and writing skills. Excellent verbal skill sets to communicate in conference calls and large meetings.
15. Team player with a strong work ethic.
16. Ability to multi-task in a fast-paced environment and prioritize workload to meet deadlines.
17. Self-starter that can take the lead on a project and manage its progress for completion. Detail-oriented and able to look at large data sets.
18. Excellent organizational capabilities with the ability to develop partnerships and strong working relationships within the organization and with the PBM.
19. Ability to interact effectively and professionally with all levels of staff.
20. Advanced skills with Microsoft Office 2016 e.g., Word, Excel, Access, SQL, and PowerPoint. Familiarity with Tableau is preferred.

What's in it for you?
• Base salary range: $25.38 to $40.62 per hour
• Internal title - Pharmacy Technician, Sr.
• Work Mode - Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. A background check is required.