Specialty Pharmacy Prior Authorization Pro

1200 MH-Memphis Hospitals; Indianapolis (IN); On-site; USD 42,000 - 60,000; Full time

Job summary

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.

The ideal candidate will have 3–5 years of pharmacy experience, strong knowledge of medical terminology, and

Qualifications

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

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

Prescription processing

EMR documentation

Medical terminology

Attention to detail

Verbal communication

Written communication

Problem-solving

Healthcare IT systems

Education

High School Diploma or equivalent

Tools

EMR systems

Microsoft Word

Job description

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.

The ideal candidate will have 3–5 years of pharmacy experience, strong knowledge of medical terminology, and