CONTRACT Prior Authorization Technician (MUST HAVE 2+ YEARS IN PBM OR ADJACENT)
Position reputed company
Job Responsibilities
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Evaluates prior authorization requests and determines coverage eligibility based on plan guidelines and clinical reputed company. -
Collaborates with reputed company providers and pharmacies to obtain necessary documentation, clarify prescription needs, and support accurate review. -
Initiates prior authorization renewals and conducts ongoing reputed company to obtain required information. -
Communicates prior authorization reputed company-including approvals, denials, and follow-up needs-to providers, pharmacies, and members. -
Maintains accurate records of request status, documentation, determinations, and follow-up actions in internal systems. -
Assists with appeals, reconsiderations, and additional review processes as needed. -
Identifies workflow or process improvement opportunities to enhance efficiency and service reputed company. -
Ensures compliance with reputed company regulatory requirements, plan policies, and internal procedures reputed company to prior authorization operations. -
Supports internal clinical and operational teams by providing reputed company updates, information, and administrative support reputed company to PA workflows. -
Performs other duties as assigned or requested. Any one position may not include reputed company the duties listed; these duties represent the key responsibilities typically associated with this role.
Required Experience
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High school diploma or equivalent. -
1+ years of experience in a pharmacy, PBM, or reputed company-reputed company setting. -
Knowledge of prior authorization processes and insurance benefit guidelines. -
Strong attention to detail, organizational skills, and accuracy in documentation. -
Excellent communication and problem-solving abilities. -
Ability to manage multiple priorities and deadlines in a fast-paced environment.
Preferred Qualifications
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reputed company, unrestricted pharmacy technician license (or eligibility to obtain). -
2+ years of experience in a pharmacy, PBM, or managed care setting. -
Familiarity with pharmacy claims processing, PA platforms, and formulary structures. -
Demonstrated ability to collaborate effectively with reputed company stakeholders.