Specialty Pharmacy Prior Authorization Specialist

MaineHealth; Westbrook (ME); On-site; USD 30,000 - 40,000; Full time

Job summary

MaineHealth Corporate is seeking a Pharmacy Prior Authorization Technician to coordinate and process prior authorizations (PAs) for prescription medications. You will work with providers, pharmacists, payers, and patients using EHRs and payer portals to document and expedite PA submissions.

The role focuses on specialty medications initially, with potential expansion over time to adapt to changing clinic needs.

Qualifications

• High school diploma or equivalent.
• Active Pharmacy Technician license (CPhT required).
• One year of experience as a licensed pharmacy technician.

Responsibilities

• Review orders needing prior authorization.
• Initiate PA requests via electronic portals (e.g., CoverMyMeds, Surescripts, payer websites).
• Communicate with insurers to gather coverage requirements and status updates.
• Collaborate with providers and pharmacists for required clinical documentation.
• Document PA status in Epic using SmartPhrases and encounters.
• Notify providers of PA outcomes and assist with alternative medication strategies.
• Track and manage open prior authorizations to ensure timely resolution and refill coordination.
• Provide status updates to clinic staff and patients as allowed.
• Stay updated on payer formulary changes and authorization requirements.
• Participate in quality improvement and workflow optimization.

Skills

Pharmacy Technician

CPhT Certification

PA processing

EHR navigation

Education

High school diploma or equivalent

Tools

Epic

CoverMyMeds

Surescripts

Job description

MaineHealth Corporate is seeking a Pharmacy Prior Authorization Technician to coordinate and process prior authorizations (PAs) for prescription medications. You will work with providers, pharmacists, payers, and patients using EHRs and payer portals to document and expedite PA submissions.

The role focuses on specialty medications initially, with potential expansion over time to adapt to changing clinic needs.