Remote-Eligible Pharmacy Prior Authorization Technician

Excellus Health Plan Inc.; Buffalo (NY); Hybrid; USD 29,000 - 46,000; Full time

Job summary

Excellus Health Plan Inc. in Buffalo, NY seeks a Managed Care Pharmacy Technician under supervision of a licensed pharmacist to support pharmacy benefits and the prescription process.

You will handle live calls with members, physicians, and pharmacists, assist with prior authorization under supervision, and help implement formulary utilization tools. The role involves data entry, reviewing medical documentation, real-time authorization, and rotating on-call duties, with exposure to the Facets

Qualifications

• HS diploma with 2+ years health-related experience; associate degree preferred.
• Pharmacy Technician certification (CPhT), LPN, or Medical Assistant/Technologist background preferred.
• Basic medical terminology and diagnosis code understanding.
• Proficient with Microsoft Office.

Responsibilities

• Review medical exception requests using pharmacist-created algorithms.
• Assess prior authorization requests with physicians' documentation.
• Enter data and monitor member profiles for PRN requests and reports.
• Provide telephone information to physicians/pharmacists about initiatives.
• Authorize real-time prescription requests for vacation supplies or therapy overrides.
• Implement formulary utilization tools like prior auth, step therapy, dose limits.
• Collaborate with internal/external stakeholders to resolve system issues.
• Research mail-order, specialty pharmacy, or claims in the Facets system.
• Support PBM interfaces for eligibility, claims, formulary checks.
• Attend staff meetings and follow quality standards.

Skills

Communication

Customer service

Problem solving

Professionalism

Independence

On-call readiness

Education

High school diploma

Associates degree preferred

CPhT/LPN/MA background preferred

Tools

Facets system

Microsoft Office

Job description

Excellus Health Plan Inc. in Buffalo, NY seeks a Managed Care Pharmacy Technician under supervision of a licensed pharmacist to support pharmacy benefits and the prescription process.

You will handle live calls with members, physicians, and pharmacists, assist with prior authorization under supervision, and help implement formulary utilization tools. The role involves data entry, reviewing medical documentation, real-time authorization, and rotating on-call duties, with exposure to the Facets