Prior Authorization Pharmacy Technician

Medix; Plano (TX); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Paid sick leave

Health benefits

401k

Short-term disability

Term life insurance

Job summary

JobRx, Inc. is seeking a skilled Prior Authorization Specialist to join its healthcare operations team. The role focuses on managing and processing prior authorization requests to ensure timely patient care and compliance with policies.

The ideal candidate has at least 2 years of full PA lifecycle experience, familiarity with CoverMyMeds, and a licensed Pharmacy Technician with retail experience is preferred. Onsite schedule is Monday to Friday, 8:30 a.m. – 5:00 p.m.

Qualifications

• MUST have at least 2 years of experience managing the full PA lifecycle including benefit investigation, document collection, PA submission, follow-up, appeals, etc.
• Experience with CoverMyMeds highly preferred.
• Licensed Pharmacy Tech with retail experience preferred.

Responsibilities

• Prior Authorization Submission & Processing: Prepare and submit PA requests through payer portals, fax, phone, or electronic systems with required documentation.
• Prior Authorization Status Follow-Up: Contact insurers to obtain real-time status updates and resolve delays.
• Reject Code Review & Resolution: Interpret and address payer edits and claim rejections to determine next steps.
• Documentation & Data Entry: Enter PA letters, authorization numbers, and related details into CareTend and other systems.
• Denial Review & Routing: Review denial letters and route to Clinical Utilization Team for review and appeals.
• Queue & Workflow Management: Monitor PA queues to ensure timely follow-up and prioritization.
• Payer Communication & Tracking: Maintain notes of interactions, reference numbers, and authorization status.

Skills

PA lifecycle experience

CoverMyMeds experience

Education

Licensed Pharmacy Technician

Job description

Job Summary

Our client is seeking a skilled Prior Authorization Specialist to join their team. The primary responsibility of this role is to manage and process prior authorization requests to ensure timely patient care and compliance with applicable policies and procedures.

Schedule

Monday - Friday, 8:30 a.m. - 5:00 p.m., ONSITE

Requirements

• MUST have at least 2 years of experience managing the full prior authorization lifecycle including benefit investigation, document collection, PA submission, follow-up, appeals etc)
• Experience with CoverMyMeds highly preferred
• Licensed Pharmacy Tech with retail experience preferred

Duties

• Prior Authorization Submission & Processing: Prepare and submit prior authorization requests through payer portals, fax, phone, or electronic systems, ensuring all required clinical and insurance documentation is included and submitted accurately and timely.
• Prior Authorization Status Follow‑Up: Proactively contact insurance companies via phone, portals, or fax to obtain real‑time status updates on submitted prior authorization requests and resolve pending issues to prevent delays in patient therapy.
• Reject Code Review & Resolution: Interpret and work insurance reject codes, payer edits, and claim rejections to identify root causes, determine required next steps, and coordinate appropriate resolution or escalation.
• Documentation & Data Entry: Accurately enter PA approval letters, authorization numbers, effective dates, denial documentation, and payer communications into CareTend and other applicable systems.
• Denial Review & Routing: Review PA denial letters for completeness and clarity, ensuring all required documentation is captured before forwarding cases to the Clinical Utilization Team for clinical review and appeal determination.
• Queue & Workflow Management: Monitor assigned PA work queues to ensure timely follow‑up, proper prioritization, and prevention of delays in therapy initiation or continuation.
• Payer Communication & Tracking: Maintain detailed and accurate notes of payer interactions, including call outcomes, reference numbers, authorization status, reject details, and next steps in accordance with internal documentation standards.

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.

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).

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.