REMOTE Prior Authorization Pharm Tech

Job Description

Job Description

The Prior Authorization Pharmacy Technician is responsible for supporting members, providers, and pharmacies by processing prior authorization requests for prescription medications while ensuring excellent customer service, accuracy, and compliance with regulatory requirements. The Pharmacy Technician will answer inbound calls (up to 50 to 70 calls per day) from providers/members and electronic inquiries related to prior authorizations (PAs) with a high level of professionalism, empathy, and customer service. Demonstrate the ability to accurately capture and verify information provided by prescribers, members, and pharmacies to support timely and compliant medication access decisions. This role involves receiving and reviewing authorization requests via phone, fax, and electronic systems, gathering and verifying clinical information, documenting interactions, evaluating requests against coverage criteria and benefit plans, and collaborating with pharmacists to support coverage determinations. The technician manages a high-volume workload, prioritizes requests based on service level agreements and turnaround times, maintains accurate records, resolves coverage-related issues, and communicates effectively with providers, members, pharmacies, and internal teams to facilitate timely access to medications and positive patient outcomes. This position will take incoming requests for prior authorizations, for formulary and non-formulary medications (this can include Commercial, Part D, High Touch Clients, Community and State cliental, Adherence and Monitoring and Prior Authorization Clinical Appeals), while ensuring a high level of customer service and maximizing productivity. Requests can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

Required Skills & Experience

-Active National (PTCB) and or State Board of Pharmacy Technician Licensure

-6+ months of customer service/ customer relations with healthcare professionals

-Technology savvy - Basic proficiency with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document) and basic proficiency with Microsoft Outlook (ability to send emails) and working skills with a PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)