Specialty Pharmacy Prior Authorization (call center/support tech)

1200 MH-Memphis Hospitals; Indianapolis (IN); On-site; USD 42,000 - 56,000; Full time

Job summary

Methodist Le Bonheur (MLH) seeks a Pharmacy Technician to precertify eligible medications for inpatient and outpatient services, ensuring documentation meets insurer guidelines for medical necessity and payment.

You will review clinical information, verify orders, and determine CPT/HCPCS/ICD-10 codes for prior authorization, coordinating with insurers and internal teams as needed.

Qualifications

• High School Diploma or equivalent.
• 3–5 years of pharmacy experience (clinical, hospital, outpatient, or specialty).
• Active pharmacy technician license as required by state board.
• Certification as Pharmacy Technician (PTCB) required.
• ExCPT certification preferred.
• Mississippi Board of Pharmacy certification preferred.

Responsibilities

• Precertify eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity.
• Review clinical information submitted by providers to evaluate necessity, appropriateness, and efficiency of prescription use.
• Verify physician orders and determine CPT, HCPCS, and ICD‑10 codes for prior authorization.
• Contact insurance companies and third‑party administrators to gather information and coordinate workflow.
• Collect, read, and interpret medical documentation to ensure compliance with insurer reimbursement guidelines and proper charge capture.
• Act as primary contact with physicians/physician offices to obtain required documentation.
• Educate providers on pre‑certification protocols and maintain ongoing rapport.
• Communicate information to Patient Access, Case Management, and other internal stakeholders regarding contract guidelines and requirements.
• Research denials or problematic accounts, identify trends, and recommend process improvements.

Skills

EMR documentation

Third-party authorization

Medical terminology

Attention to detail

Communication skills

Education

High School Diploma or equivalent

Certified Pharmacy Technician – Pharmacy Technician Certification Board (PTCB)

Certified Pharmacy Technician – ExCPT (National Healthcareer Association)

Pharmacy Technician license – Tennessee Board of Pharmacy

Pharmacy Technician license – Mississippi Board of Pharmacy

Job description

About the Role

Methodist Le Bonheur (MLH) is seeking a Pharmacy Technician to perform precertification of eligible prescription medications for inpatient and outpatient services. The role ensures complete documentation meets insurer guidelines for medical necessity and payment, supports patient assistance coordination, and serves as primary contact with physicians to obtain required documentation.

Responsibilities

• Precertify eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity.
• Review clinical information submitted by providers to evaluate necessity, appropriateness, and efficiency of prescription use.
• Verify physician orders and determine CPT, HCPCS, and ICD‑10 codes for prior authorization.
• Contact insurance companies and third‑party administrators to gather information and coordinate workflow.
• Collect, read, and interpret medical documentation to ensure compliance with insurer reimbursement guidelines and proper charge capture.
• Act as primary contact with physicians/physician offices to obtain required documentation.
• Educate providers on pre‑certification protocols and maintain ongoing rapport.
• Communicate information to Patient Access, Case Management, and other internal stakeholders regarding contract guidelines and requirements.
• Research denials or problematic accounts, identify trends, and recommend process improvements.

Education and Work Experience

• High School Diploma or equivalent.
• 3–5 years of pharmacy experience (clinical, hospital, outpatient, or specialty).

Licenses and Certifications

• Pharmacy Technician – Tennessee Board of Pharmacy.
• Certified Pharmacy Technician – Pharmacy Technician Certification Board (required).
• Preferred: Certified Pharmacy Technician – ExCPT (National Healthcareer Association).
• Preferred: Pharmacy Technician – Mississippi Board of Pharmacy.

Knowledge, Skills & Abilities

• Basic understanding of prescription processing flow.
• Expertise in utilizing EMRs to document clinical criteria for third‑party approval.
• Knowledge of medical terminology, drug nomenclature, symbols, and abbreviations in pharmacy practice.
• Strong attention to detail and critical thinking skills.
• Effective verbal and written communication with patients, associates, and health professionals.
• Ability to diagnose situations and recommend resolution strategies.
• Experience with computerized healthcare information systems.
• Proficiency with Microsoft Word.

Supervision

No supervisory responsibilities are assigned to this position.

Physical Demands

Physical activities may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion. The position requires good balance, coordination, and visual acuity. Light work involves lifting up to 25lbs occasionally or up to 10lbs frequently. The work is performed in general office or administrative settings without substantial exposure to adverse environmental conditions.