Medication Adherence and Prior Authorization Technician

Legacy Community Health is a premium, Federally Qualified Health Center (FQHC) that provides comprehensive care to community members regardless of their ability to pay. Our goal is to treat the entire patient while improving their overall wellness and quality of life, in addition to providing free pregnancy tests, HIV/AIDS screening. At Legacy, we empower patients to lead better lives by promoting healthy behaviors and offering resources such as literacy classes, family planning services, and nutrition and weight management information.

Our roots began in 1981 as the Montrose Clinic, with specialization in HIV education, testing, and treatment. Since then, the agency has expanded to >50 clinics in Houston, one in Baytown, two in Beaumont, and one in Deer Park with extensive services that include: Adult primary care, HIV/AIDS care, pediatrics, OB/GYN and maternity, dental, vision and behavioral health. We also service students within KIPP and YES Prep schools. Legacy is committed to driving healthy change in our communities.

Job Description

Ensures patients have access to medications by:

• processing medication renewal requests per procedure
• processing medication prior authorization for both pharmacy and medical coverage
• provide outreach effort to those clients who are at risk of falling out of care by scheduling appointments and provide prescription refills as needed

Essential Functions

• Serve as liaison between Legacy client and the provider/pharmacy to minimize time between medication needs are met.
• Monitor all incoming requests for prescription renewals (i.e. from electronic renewal requests, pharmacies, and patients) and respond as per protocol within 48 hours of receipt.
• Identify requests that fall outside prescription renewal guidelines and seeks assistance from pharmacist and providers, when appropriate.
• Demonstrates ability to understand provider’s plan for appropriate patient’s follow-up.
• Take proactive actions to ensure patients’ continued accessibility to prescriptions. These actions include but not limited to making an appointment, providing refill, communicating with provider, and obtain lab orders when necessary.
• Monitor and respond to incoming prior authorization requests promptly.
• Demonstrate proficiency in medication prior authorization process including verification of benefit, gathering relevant clinical information, submitting prior authorization (both pharmacy and medical), and preparing appeals as necessary.
• Maintains accurate and updated documentation for all activities in Legacy’s EMR and Pharmacy system.
• Communicate effectively and timely with internal and external stakeholders
• Performs additional duties as assigned.

EDUCATION & TRAINING REQUIREMENTS

• High School Diploma or equivalent required
• Certification as a Pharmacy Technician
• Basic Life Support (BLS) Certification
• Bilingual (Spanish) preferred

WORK EXPERIENCE REQUIREMENTS

• Minimal 5 years’ experience as a pharmacy technician

Benefits

As part of values that Healthcare is a Right and not a Privilege, we offer a suite of benefits

• Medical / Vision / Dental (Costs of benefits are based on your yearly salary)
  • Medical visit copays are waived when seeing a Legacy provider.
• 9 Holiday 1 Floating Holiday
• 403b Retirement Plan
• Bright Horizons Back-up Care
  • As a user of Bright Horizons Back-Up Care, you can conveniently schedule care right from your mobile device with the Back-Up Care app– your easy, time-saving solution to managing family care challenges while on the go.
• Paid Time Off (PTO)
  • PTO Exchange benefit

PTO Exchange will provide you with the option to convert a portion of your accrued but unused PTO hours for use toward several different benefits and causes, based on your own priorities.

With PTO Exchange, you can convert a portion of your unused PTO into:

• 403(b) Retirement contributions
• Student loan payments / Tuition for the employee
• Leave Sharing donations to fellow employees