Prior Authorization Navigator & Patient Access Specialist

Shields Health Solutions; United States; On-site; USD 38,000 - 52,000; Full time

Job summary

Shields Health Solutions is seeking a Pharmacy Technician to support patient access by working with insurers, clinicians, and funding sources to obtain prior authorizations and financial assistance, while providing phone support and navigating pharmacy systems to adjudicate claims and process refills.

The role emphasizes collaboration with pharmacists, maintaining accurate records, promoting medication adherence, and contributing to process improvements.

Qualifications

• Experienced, state-registered pharmacy technicians; licensure within 6–9 months as applicable; national certification (PTCB or NHA) preferred or required.
• Minimum 1+ year of experience as a Pharmacy Technician.
• High school diploma or GED required.

Responsibilities

• Communicate directly with insurance companies to facilitate medication approvals.
• Navigate pharmacy operating systems to input data, adjudicate test claims, and develop action plans for follow-up.
• Document patient concerns, prior authorization status, and financial assistance needs across databases and EMR.
• Review prescriptions with physicians' offices to ensure optimal patient care.
• Maintain complete and accurate records of patient communications.
• Assist patients with managing their pharmacy insurance claims.
• Collaborate with pharmacists and pharmacy liaisons to deliver coordinated patient care.
• Communicate with patients by phone to support medication adherence.

Skills

Pharmacy technician

Microsoft Office

Data entry

Education

High school diploma or GED

Tools

Microsoft Office Suite

Job description

Shields Health Solutions is seeking a Pharmacy Technician to support patient access by working with insurers, clinicians, and funding sources to obtain prior authorizations and financial assistance, while providing phone support and navigating pharmacy systems to adjudicate claims and process refills.

The role emphasizes collaboration with pharmacists, maintaining accurate records, promoting medication adherence, and contributing to process improvements.