Specialty Pharmacy Prior Authorization Expert

Methodist Le Bonheur Healthcare; Memphis (TN); On-site; USD 25,000 - 36,000; Full time

Job summary

Methodist Le Bonheur Healthcare in Memphis, TN seeks a Pharmacy Technician focused on precertification for inpatient and outpatient prescriptions. You will verify medical necessity, ensure complete documentation, and collaborate with physicians and insurer representatives to secure approvals.

The role requires strong knowledge of medical terminology, EMR usage, and accurate coding for prior authorizations. Excellent communication skills and attention to detail are essential, with opportunities

Qualifications

• Pharmacy technician with clinic, hospital, outpatient, or specialty experience.
• Knowledge of medical terminology and drug nomenclature essential.
• Ability to document criteria for third party approval using EMRs.

Responsibilities

• Precertify eligible prescription medications for inpatient and outpatient services according to medical plan documents.
• Ensure documentation meets insurer guidelines for medical necessity and payment.
• Review clinical information to evaluate necessity and efficiency of prescribed medications.
• Assist patient assistance and grant coordination for outpatient pharmacies.
• Contact insurers to gather information and organize workflow for procedures.
• Verify physician orders, determine CPT/HCPCS/ICD-10 codes for prior authorization.
• Serve as liaison with physicians and offices to collect documentation per guidelines.
• Identify trends and root causes to improve future processes.

Skills

Communication skills

Attention to detail

Critical thinking

Problem solving

Team collaboration

Education

High School Diploma or Equivalent

Registered Pharmacy Technician - Tennessee Board of Pharmacy

Certified Pharmacy Technician - PTCB

ExCPT Certification - NHA

Pharmacy Technician Certification - Mississippi Board (Preferred)

Tools

EMR systems

Microsoft Word

Job description

Methodist Le Bonheur Healthcare in Memphis, TN seeks a Pharmacy Technician focused on precertification for inpatient and outpatient prescriptions. You will verify medical necessity, ensure complete documentation, and collaborate with physicians and insurer representatives to secure approvals.

The role requires strong knowledge of medical terminology, EMR usage, and accurate coding for prior authorizations. Excellent communication skills and attention to detail are essential, with opportunities