What are the responsibilities and job description for the Pharmacy Technician - Prior Authorizations position at SCAN Health Plan?
The Job
The Prior Authorization Pharmacy Technician will play a key role in supporting the prior authorization (PA) process for prescription medications. This individual will collaborate with healthcare providers, pharmacies, and insurance companies to ensure timely approval of medications, minimize delays in patient care, and promote efficient use of healthcare resources. The ideal candidate has strong knowledge of managed care practices, clinical protocols, and pharmacy operations, with a focus on prior authorizations and formulary management.
You Will
Review and Process Prior Authorizations : Evaluate and process PA requests for prescription medications based on clinical guidelines and insurance policies.
Coordinate with Providers and Pharmacists : Communicate with healthcare providers to gather necessary clinical information and ensure documentation meets PA requirements.
Utilization of Pharmacy Benefit Management (PBM) Systems : Input, track, and manage prior authorization requests using PBM systems and other managed care platforms.
Adherence to Regulatory Guidelines : Ensure compliance with federal and state regulations, insurance policies, and organizational procedures when processing prior authorization requests.
Documentation and Reporting : Maintain accurate and up-to-date records of all PA activities, including approvals, denials, and follow-up requests.
Customer Service : Respond to inquiries from patients, providers, and internal teams regarding the status of PA requests and related processes.
Continuous Improvement : Assist in identifying opportunities for improving prior authorization workflows and patient outcomes, collaborating with clinical teams to refine processes.
Educate Providers : Provide information to physicians and healthcare teams regarding formulary changes, clinical alternatives, and PA criteria as needed.
All other duties as assigned.
Your Qualifications
High School Diploma or equivalent experience. Bachelor's Degree preferred.
Pharmacy Technician License for the State of California is preferred.
Minimum 5 years of experience in a managed care setting, specifically focused on prior authorization and pharmacy benefit management.
Experience with file management and working with different file formats ( text files).
Regulatory audit experience.
Experience managing small projects from inception through completion.
Claims adjudication experience is preferred.
Experience with analyzing and trending claims data.
Technical expertise - Advanced analytical skills
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal skills
Expert knowledge of CMS Medicare Part B and D benefits, rules and regulations.
PDE knowledge of error resolution and calculations.
Excellent grammar and writing skills. Excellent verbal skill sets to be able to communicate in conference calls and in large meetings.
Team player with a strong work ethic.
Ability to multi-task in a fast pace environment. Ability to prioritize workload and meet deadlines.
Self-starter that can take the lead on a project and manage its progress for completion. Detail oriented and is able to look at large data sets.
Excellent organizational capabilities with ability develop partnerships and strong working relationships within the organization and with the PBM.
Ability to interact effectively and professionally with all levels of staff.
Advanced skills with Microsoft Office 2016 , Word, Excel, Access, SQL and PowerPoint. Familiarity with Tableau is preferred.
What's in it for you?
- Base salary range : $ to $ per hour
- Internal title - Pharmacy Technician, Sr.
- Work Mode - Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
