Prior Authorization Pharmacy Technician

Shieldshealthsolutions; United States; Remote; USD 28,000 - 30,000; Full time

Benefits offered by this job

Quarterly bonus opportunities

Job summary

Shields Health Solutions is seeking an experienced Pharmacy Technician to support patient care by removing barriers to medication access. You will work with insurance companies and clinician offices to facilitate prior authorizations and assist patients with financial support for high-cost copays.

You will handle phone support, navigate pharmacy systems to adjudicate claims, process refills, and promote medication adherence. A minimum 1 year of experience and a high school diploma are required.

Qualifications

• 1+ year of experience as a Pharmacy Technician.
• State registration/licensing per state requirements.
• Ability to use Microsoft Office and navigate data systems.

Responsibilities

• Communicate with insurance to facilitate medication approvals.
• Navigate pharmacy systems to input data and adjudicate claims.
• Document patient concerns and authorization status across systems.
• Review prescriptions with physicians to ensure optimal care.
• Maintain accurate records of patient communications and data.
• Assist patients with managing pharmacy insurance claims.
• Support adherence and collaborate with pharmacists for coordinated care.

Skills

Pharmacy Technician

Communication skills

Attention to detail

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Schedule:

Full-time, Monday through Friday. Occasional weekend rotation as needed during busy / holiday seasons.

Job Purpose:

In this role, the individual will support patient care by removing barriers to medication access. This includes working with insurance companies and clinician offices to facilitate medication approvals through prior authorizations, as well as collaborating with patients and various funding sources, such as foundations or pharmaceutical manufacturers, to obtain financial assistance for high-cost copays. The role also involves providing phone support to patients, navigating pharmacy dispensing systems to adjudicate claims, process refills, and promoting medication adherence.

Job Duties:

• 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.
• Communicate effectively across databases, electronic medical records, and email systems to document patient concerns, prior authorization status, and financial assistance needs.
• 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 closely with pharmacists and pharmacy liaisons to deliver a coordinated, high-quality patient care experience.
• Communicate directly with patients via phone to support medication adherence and compliance.
• Research and analyze information to support strategic decision-making.
• Manage, organize, and update relevant data within database systems.
• Apply observations and recommendations to improve operations, productivity, quality, and customer service standards.
• Identify trends, resolve issues, recommend improvements, and implement changes.
• Participate actively in process improvement initiatives.
• Act as a value-added business partner to stakeholders across the organization.
• Protect organizational value by maintaining confidentiality of information.
• Maintain professional knowledge by participating in educational opportunities, reading professional publications, and engaging in professional networks and organizations.
• Minimal in-state or out-of-state travel may be required.
• Perform other duties as assigned.

Compensation:

The compensation range for this full-time, hourly position is $20.00-$22.00 per hour. In addition, team members are eligible for quarterly bonus opportunities based on the achievement of performance metrics and goals.

Experience/ Education:

Required Licensure/Certification: We are seeking experienced, state registered pharmacy technicians. If the candidate lives in a state that does not require registration (Delaware, Hawaii, New York), then the candidate agrees to obtain a state license within 6 months of employment and must be nationally certified (PTCB or NHA) at time of hire. In all other cases, PTCB or NHA is highly preferred but not required (must be obtained within 9 months of employment). Should additional licensure need to be obtained, the applicant will commit to obtaining the required licensure within a mutually agreed upon timeframe. Continued employment is contingent upon meeting these requirements.

Years of Experience: Required 1+ years as a Pharmacy Technician

Education: High school diploma or GED required

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Solid computer skills are required, including proficiency in Microsoft Office tools (Outlook, Teams, Word, Excel, and PowerPoint) for communication, documentation, and data management, as well as, navigating the internet and web-based platforms. Data entry and computer skills will be evaluated through an assessment as part of the pre-employment process.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Shields Health Solutions is committed to providing an inclusive hiring experience; if you need assistance or accommodation during the application or interview process, please email [e-mail].