Pharmacy Prior Authorization Technician

Description

Professional - Clinical
Req #: 43030

Summary:

ThePharmacy Prior Authorization Technicianis responsible for coordinating and processing prior authorizations (PAs) for prescription medications to ensure timely patient access to treatment. Working closely with providers, pharmacists, payers, and patients, the technician utilizes theEHRand payer portals to facilitate and document the PA process. This role is key to supporting the clinical team in minimizing treatment delays and improving medication access. This is a hybrid role that allows working remotely with the ability to come in-office for training and as needed. All experience levels are encouraged to apply. This role is included in th pharmacy technician ladder program, with compensation accounting for experience and certification.

Key Responsibilities

• Review medication orders routed to queue
• Initiate and complete prior authorization requests through electronic portals (e.g., CoverMyMeds, Surescripts, payer websites).
• Communicate with insurance companies to gather coverage requirements and status updates.
• Collaborate with providers and pharmacists to obtain necessary clinical documentation for PA submissions.
• Document PA status, approvals, denials, and follow-ups
• Notify providers of PA outcomes and assist with alternative medication strategies when necessary.
• Track and manage open prior authorizations to ensure timely resolution and refill coordination.
• Support clinic staff, pharmacy staff and patients by providing status updates or coverage information as allowed.
• Maintain up-to-date knowledge of payer formulary changes and authorization requirements.
• Participate in continuous quality improvement and workflow optimization efforts.
• Other pharmacy technician tasks as assigned

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: Associate's Degree preferred.
2. License/Certifications: Current or eligible for applicable state(s) license as a Pharmacy Technician. CPhT or PTCB certificate is required within one year of hire.
3. Experience: Five years of experience as a pharmacy technician in healthcare or related environment required. Demonstrates competency in all essential functions of a Pharmacy Technician III role.
4. Additional Skills/Requirements Required: N/A
5. Additional Skills/Requirements Preferred: N/A

If you have questions about this role, please contact todd.nevins@mainehealth.org