Prior Authorization Pharmacy Technician

Job Title: Prior Authorization Pharmacy Technician

Job Description

• Determine patients' insurance requirements for pre-certification, patient payments, and coverage limitation and take necessary action prior to patient discharge.

• Maintain communication with unit-based clinical pharmacists, social workers, and discharge pharmacy program administrators to obtain complete and accurate financial information required for claim adjudication.

• Communicate any discrepancies immediately to unit-based clinical pharmacists and discharge concierge program administrators to avoid delays in discharge.

• Fax all necessary information to insurance companies to obtain an authorization number for pre-certification, and communicate this number to discharge concierge program staff to allow for prescription processing and fulfillment.

• Support all Concierge Service-related activities from prescription intake to bedside delivery at the time of patient discharge when required.

• Collaborate with internal team members to gather appropriate paperwork, prescriptions, billing information, and other necessary documentation.

• Provide follow-up communication to patients and their families regarding pharmaceutical needs and additional eligibility information to ensure ongoing medication access.

• Interact with medical staff and their designees to obtain complete, accurate, and timely clinical and financial information required for payer reimbursement.

• Collaborate with internal team members, insurance companies, drug manufacturers, and prescription benefit administrators to coordinate drug coverage or resolve denials.

• Follow up with all review companies on all pending authorizations and referrals.

Hard Skills

• 2-3 years of retail pharmacy experience

• Experience with insurance prior authorizations (preferred)

• CPHT (PTCB) certification

Job Type

This is a Contract-to-Hire position with a duration of 6 Month(s).

Work Site

This is a fully remote position after training is complete.

Work Environment

Shift is flexible and can start any time from 7:30 am-9 am but must work an 8.5-hour shift with a 30-minute unpaid lunch. Pharmacy Tech will work on-site for the first 8-10 weeks prior to transitioning to a fully remote role.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.