Pharmacy Technician - Outpatient Prior Authorizations

Overview:

 

Primarily supports the Hematology/Oncology/Bone Marrow Transplant Clinic. May also support other clinics and operations as needed.

Submissions can be for Medical and/or Pharmacy Benefit.

Interacts with clinics (including Nursing, Providers, and Pharmacists), pharmacy leadership, insurance companies, and pharmacy benefit managers. May interact with the hospital’s patient accounts, revenue cycle, and payor relations team as needed.

 

Job Description Summary:

 

The Medication Access technician plays a critical role in supporting patients and healthcare teams by ensuring timely and efficient access to select medications. This position is responsible for conducting benefits investigations, submitting prior authorizations, and assisting with denial management and will collaborate with pharmacy and clinic teams to streamline communication, resolve access issues, and provide exceptional customer service. This role requires strong attention to detail to accurately document information, problem-solving skills to navigate medication access challenges, and accountability to ensure alignment with processes and patient needs.

 

Job Description:

 

Essential Functions:

• Performs benefits investigation and submits prior authorizations for select medications and clinics within the organization.

• Provides support for prior authorization denial management including appeals, patient assistance program applications, and claims review, as needed.

• Assist clinic team members and patients/caregivers with medication access to select medications including working with external pharmacies and copay assistance programs, as needed.

• Gather necessary information to support the medication access process and document clearly and appropriately within the electronic health record.

• Collaborate with pharmacy and clinic team members and external stakeholders (e.g., insurance providers) to ensure seamless and effective communication and coordination of care.

Education Requirement:

High school diploma or equivalent.

Licensure Requirement:

Pharmacy technician registration with the Ohio Board of Pharmacy with certificated pharmacy technician registration preferred.

Certifications:

Completion of a pharmacy technician training program or certification by examination as a pharmacy technician (i.e., CPhT, ExCPT) prior to start state, required.

Skills:

• Effective interpersonal, verbal, and written communication skills.
• Ability to problem solve and work independently.

Experience:

• Two (2) years of experience as a pharmacy technician in a pharmacy area related to the position, preferred.
• Pharmacy or medical billing experience, preferred.

Physical Requirements:

OCCASIONALLY: Bend/twist, Lifting / Carrying: 11-20 lbs, Lifting / Carrying: 21-40 lbs, Pushing / Pulling: 0-25 lbs, Pushing / Pulling: 26-40 lbs, Squat/kneel

FREQUENTLY: Decision Making, Interpreting Data, Lifting / Carrying: 0-10 lbs, Problem solving, Sitting, Standing

CONTINUOUSLY: Audible speech, Chemicals/Medications, Color vision, Computer skills, Depth perception, Flexing/extending of neck, Hand use: grasping, gripping, turning, Hearing acuity, Peripheral vision, Reaching above shoulder, Repetitive hand/arm use, Seeing – Far/near, Walking

Additional Physical Requirements performed but not listed above:

(not specified)

 

 

"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"