Prior Authorization Pharmacy Tech

Medix; Maryland; On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Paid Sick Leave

Health Benefits

Dental & Vision Insurance

401k Plan

Short Term Disability

Term Life Insurance

Job summary

Medix Staffing Solutions, Inc. is seeking a Prior Authorization Pharmacy Technician to evaluate and determine coverage for prior authorization requests, ensure decisions align with clinical criteria and plan guidelines.

You will coordinate with providers, pharmacies, and members, document case details, and support appeals while maintaining compliance with regulatory standards and plan policies.

Qualifications

• Active pharmacy technician license.
• Knowledge of prior authorization processes and insurance benefit guidelines.
• Strong attention to detail and documentation accuracy.
• Excellent communication and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced environment.

Responsibilities

• Evaluate and determine PA coverage using clinical criteria and plan guidelines.
• Coordinate with providers, pharmacies, and members to gather documentation.
• Maintain complete records of PA requests, renewals, determinations, and follow-ups.
• Support appeals and administrative workflow for efficient operations.
• Adhere to regulatory standards and identify process improvements.

Skills

PA platforms

pharmacy claims processing

formulary structures

communication

Education

Pharmacy Technician Certification

Tools

Pharmacy PA platforms

Job description

Job Summary

Our client is seeking a Prior Authorization Pharmacy Technician to evaluate and determine coverage for prior authorization requests, ensuring decisions align with clinical criteria and plan guidelines. This role involves coordinating with healthcare providers, pharmacies, and members, documenting case details, and supporting appeals while maintaining strict compliance with regulatory standards and plan policies.

Key Responsibilities

• Evaluate & Determine Coverage: Review prior authorization requests and render eligibility decisions using clinical criteria and plan guidelines.
• Coordinate & Communicate: Liaise with providers, pharmacies, and members to gather clinical documentation, discuss decisions, and handle ongoing outreach.
• Document Case Details: Maintain complete, accurate records of PA requests, renewals, determinations, and follow-ups in internal systems.
• Support Appeals & Operations: Assist with review reconsiderations and provide administrative support to keep clinical workflows running smoothly.
• Maintain Compliance & Efficiency: Adhere strictly to regulatory standards and plan policies while identifying process improvements to enhance service quality.

Qualifications

• Active pharmacy technician license.
• Knowledge of prior authorization processes and insurance benefit guidelines.
• Strong attention to detail, organizational skills, and accuracy in documentation.
• Excellent communication and problem-solving abilities.
• Ability to manage multiple priorities and deadlines in a fast-paced environment.

Experience

• Experience in PBM, PBM Adjacent, Health Plan or pharmacy-related setting.

Skills

• Familiarity with pharmacy claims processing, PA platforms, and formulary structures (Preferred).
• Pharmacy Technician Certification (Preferred).

Additional Requirements

• Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

* As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients