Specialty Pharmacy PA Specialist - Impact & Precision

Methodist Le Bonheur Healthcare; Memphis (TN); On-site; USD 38,000 - 48,000; Full time

Job summary

Methodist Le Bonheur Healthcare is seeking a Pharmacy Technician for precertification of prescribed medications. You will ensure documentation meets insurer guidelines for medical necessity and payment, while reviewing clinical information for appropriateness and efficiency of medication use.

You will verify orders, determine codes for prior authorization, and liaise with insurers to gather information. The role emphasizes accuracy, EMR proficiency, and collaboration with physicians and patient

Qualifications

• Required - High School Diploma or Equivalent
• Work Experience Required - Pharmacy (clinical, hospital, outpatient, or specialty) 3-5 years
• Licenses and Certifications Required - Pharmacy Technician - Tennessee - Tennessee Board of Pharmacy
• Required - Certified Pharmacy Technician - Pharmacy Technician Certification Board
• Preferred - Certified Pharmacy Technician- ExCPT - National Healthcareer Association
• Preferred - Pharmacy Technician - Mississippi - Mississippi Board of Pharmacy

Responsibilities

• Responsible for precertification of eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity.
• Ensures medical documentation is sufficient to meet insurer guidelines for medical necessity documentation and procedure payment.
• Reviews clinical information submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of prescription medications.
• Assists with patient assistance and grant coordination for Patients for outpatient pharmacies from designated areas.
• Proactively analyzes information submitted by providers to make timely medical necessity review determinations based on appropriate criteria and standards guidelines.
• Verifies physician orders are accurate.
• Determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.
• Contacts insurance companies and third party administrators to gather information and organize work‑flow based on the requested procedure.
• Collects, reads and interprets medical documentation to determine if the appropriate clinical information has been provided for insurance reimbursement and proper charge capture.
• Serves as primary contact with physicians/physician offices to collect clinical documentation consistent with insurer reimbursement guidelines.
• Establishes and maintains rapport with providers as well as ongoing education of providers concerning protocols for pre‑certification.
• Communicates information and acts as a resource to Patient Access, Case Management, and others in regard to contract guidelines and pre‑certification requirements.
• Performs research regarding denials or problematic accounts as necessary.
• Works to identify trends and root cause of issues and recommend resolutions for future processes.

Skills

Attention to detail

Communication

Medical terminology

Critical thinking

Team collaboration

Education

High School Diploma or Equivalent

Pharmacy Technician Certification Board

Tennessee Pharmacy Technician license

ExCPT (preferred)

Tools

EMR/EHR systems

Microsoft Word

Job description

Methodist Le Bonheur Healthcare is seeking a Pharmacy Technician for precertification of prescribed medications. You will ensure documentation meets insurer guidelines for medical necessity and payment, while reviewing clinical information for appropriateness and efficiency of medication use.

You will verify orders, determine codes for prior authorization, and liaise with insurers to gather information. The role emphasizes accuracy, EMR proficiency, and collaboration with physicians and patient