Prior Authorization Technician - Pharmacy Technician Florida License required

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

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 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.

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 (i.e. Delaware, Hawaii, New York), candidate agrees to obtain a state license withing 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].