Prior Authorization Technician - Pharmacy Technician - Shields Health Solutions

Patient Support Advocate

Job Purpose:

Within this role, this person will provide patient care by removing the barriers to medication access. Working with insurance companies and clinician offices to facilitate approval of medications through prior authorizations. Working with patients and a variety of funding sources such as foundations, or directly through manufactures to obtain financial assistance for high dollar co-pays.  Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims, refill medications, and increase adherence in patients.

Job Duties:

• Directly communicate with insurance companies to facilitate the approval of medications.
• Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up.
• Effectively communicate across databases, electronic medical records and emails to document patient concerns, prior authorization status, and financial assistance needs.
• Review prescriptions with doctors' offices to ensure optimal care of the patient.
• Keep complete and accurate records of patient communications.
• Assist patients in the management of their pharmacy insurance claims.
• Work closely with pharmacists and pharmacy liaisons to provide an integrated approach quality patient care.
• Communicate directly with patients over the phone to assist them in all aspects of medication compliance.
• Research and investigate information to enable strategic decision-making by others.
• Manage, organize, and update relevant data using database applications.
• Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards.
• Identify trends, resolve problems; recommend improvements; implement change.
• Actively participate in process improvement initiatives.
• Act as a value-added business partner to stakeholders throughout the organization.
• Protect organization's value by keeping information confidential.
• Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Minimal in or out of state travel may be required.
• Perform other duties as assigned.

Experience/ Education:

Required Licensure/Certification:  We are seeking experienced pharmacy technicians who are state registered, or state certified as a pharmacy technician.  Nationally certified as a CPhT or equivalent is strongly preferred but not required.

*If the candidate's state of residence does not have a state registration available, then the National certification is required at time of hire. Should additional licensure need to be obtained, the applicant will commit to obtaining the required licensure within a mutually agreed upon timeframe. Continued employment is contingent upon meeting these requirements. 

Years of Experience: Required 1+ years as a Pharmacy Technician

Education: High school diploma or GED required