prior authorization technician

Gainwell Technologies

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 <br/>
 <br/>
 <strong>
  Summary
  <br/>
  <br/>
 </strong>
 As a Prior Authorization Pharmacy Technician &ndash; Remote, you will support our pharmacy benefit management (PBM) services by managing incoming provider inquiries, processing prior authorizations, and ensuring accurate and timely communication. Your role combines pharmacy expertise with exceptional customer service in a call center environment.
 <br/>
 <br/>
 <strong>
  Your role in our mission
  <br/>
  <br/>
 </strong>
 Help create the power in Gainwell&rsquo;s processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.
 <br/>
 <br/>
 <ul>
  <li>
   Handle inbound and outbound calls related to prior authorization requests and provider inquiries.
  </li>
  <li>
   Accurately process and document prior authorization requests within required timeframes.
  </li>
  <li>
   Provide courteous and knowledgeable support to healthcare providers across multiple communication platforms (phone, email, fax, web).
  </li>
  <li>
   Ensure all communications and data handling are compliant with HIPAA and internal confidentiality protocols.
  </li>
  <li>
   Collaborate with cross-functional teams to resolve issues and improve service delivery.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What We're Looking For
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   At least 2 years of experience as a pharmacy technician in retail, hospital, managed care, insurance, or PBM.
  </li>
  <li>
   Active pharmacy technician license.
  </li>
  <li>
   Strong communication, documentation, and problem-solving skills.
  </li>
  <li>
   Proficient in Microsoft Office, email, and internet usage.
  </li>
  <li>
   Comfortable working in a fast-paced, team-oriented, call center environment.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You Should Expect In This Role
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Remote, full-time position with scheduling flexibility based on business and operational needs
  </li>
  <li>
   Fast-paced, high-volume call center environment focused on supporting providers with accuracy and professionalism
  </li>
  <li>
   Ongoing training and development designed to strengthen pharmacy knowledge, customer support skills, and overall performance
  </li>
  <li>
   Collaborative team culture where continuous improvement, innovation, and process enhancement ideas are encouraged
  </li>
  <li>
   Comprehensive benefits package including medical, dental, vision, 401(k), paid time off, and other employee support programs
   <br/>
   <br/>
  </li>
 </ul>
 The pay range for this position is [[salaryMin]] - [[salaryMid]] per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
 <br/>
 <br/>
 We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
 <br/>
 <br/>
 <em>
  Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
  <br/>
  <br/>
 </em>
</div>


Prior Authorization Pharmacy Technician - Remote US

Ventegra

<p>Job Purpose</p><p>Ventegra is a rapidly growing, fast paced, innovative virtual company. As part of Ventegra, the Pharmacy Technician I, provide daily operational support to the Pharmacist and Customer Care Specialist related to prior authorizations. The Pharmacy Technician 1 has the clinical skills to review and evaluate the appropriateness and medical necessity of medications based on established criteria. The Pharmacy Technician I, promotes and supports quality pharmacy services.</p><p>Duties and Responsibilities</p><ul><li>Maintain an accurate and current knowledge of required criteria, training materials, systems, prior authorization processes and plan benefits</li><li>Accurately enter authorizations approvals in the claims processing system</li><li>Accurately document case notes relate to member&rsquo;s medications as required in the prior authorization review process</li><li>Review incoming fax requests for medications requiring a prior authorization, while ensuring an elevated level of customer service and maximizing productivity. Requests additional information from providers as needed to properly evaluate the request</li><li>Assist Clinical Pharmacist by providing accurate documentation and clear clinical notes related to a prior authorization request</li><li>Provide clinical review and determinations of prior authorization in keeping with legal and contractual requirements, including turnaround times and service level agreements</li><li>Escalate issues through the appropriate channel of management to ensure patient has access to medications</li><li>Effectively manages and prioritize prior authorization requests based on turn-around times</li><li>Effectively communicates both internally and externally to enhance the effectiveness of pharmacy prior authorization process and ensure the needs of the members and clients are met</li><li>Must maintain the highest level of member confidentiality and adheres to all company policies regarding confidentiality and HIPAA</li><li>Assist in the processing of telephonic prior authorizations request from physicians using established criteria and guideline</li><li>Assist with other duties and responsible as assign by management based on department needs</li></ul><p>Required Skills and Abilities</p><ul><li>Excellent verbal and written communication skills</li><li>Ability to focus and prioritize</li><li>Accurate and detail oriented</li><li>Ability to multi-task with minimal direction</li><li>Flexibility and ability to adapt to changes and updates to processes and protocols</li><li>Demonstrate problem-solving skills, information gathering, research, alternatives analysis, applying creative solutions to unique and/or immediate issues</li><li>High volume call center experience a plus</li><li>Experience processing in pharmacy prior authorization request using medication criteria</li><li>Proficient in Microsoft Office programs (Word, Excel, Outlook, etc.)</li><li>Dependability and good attendance are an essential function of the job</li></ul><p>Education and Experience</p><ul><li>High School Diploma or GED equivalent.</li><li>Current Pharmacy Technician License required; Certified Pharmacy Technician License (CPhT) required</li><li>1-year experience as a Pharmacy Prior Authorization Technician or minimum 1-year experience as a Ventegra Customer Care Specialist (CCS) with Technician Certification (CPhT required)</li></ul><p>Work environment requirements</p><p>A home office setting, free from noise and distraction allowing you to interact professionally both externally and internally.</p><p>Pay: $20.00 per hour</p><p>Work Location: Remote</p>

Clinical Pharmacy Technician I

Molina Healthcare

<p>Molina Healthcare is hiring for remote Certified Pharmacy Technicians. These roles will be in our Prior Authorization department. You will review prior auth requests that are submitted.<br/>Schedules for these role will vary between 7am to 10pm EST.<br/></p><p>Qualified candidates must have either PTCB certification or Pharmacy Tech State license. High preference for those who are self-starters and go-getters. Must have above average computer skills along with a high level of communication skills both written and verbal.<br/></p><p>As a Pharmacy Tech here at Molina, you will provide support for pharmacy technician activities. You will also contribute to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.<br/></p><p><b>Essential Job Duties</b><br/></p><ul><li>Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests.</li><li>Accurately enters approvals or denials of requests.</li><li>Facilitates prior authorization requests within established pharmacy policies and procedures.</li><li>Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices.</li><li>Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership.</li><li>Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues.</li><li>Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed.</li></ul><p><b>Required Qualifications</b><br/></p><ul><li>At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience.</li><li>Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.</li><li>Ability to abide by Molina policies.</li><li>Ability to maintain attendance to support required quality and quantity of work.</li><li>Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).</li><li>Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.</li><li>Excellent verbal and written communication skills.</li><li>Microsoft Office suite (including Excel), and applicable software program(s) proficiency.</li></ul><p>#PJPharm3<br/></p><p>#LI-AC1<br/></p><p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br/></p><p>Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V<br/></p><p>Pay Range: $12.19 - $26.42 / HOURLY<br/>*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.<br/></p>

Pharmacy Technician CPhT Prior Auth (Remote)

Onco360

<div><div><b>Pharmacy Prior Authorization Specialist &ndash; Onco360 Pharmacy</b><br>
<i>New Hyde Park, NY</i> | <i>Full-Time</i> | <i>Starting at $25.00/hr and up</i></div>
<div></div><div><b>Join a mission-driven team making a difference in the lives of cancer and rare disease patients.</b></div>
<div></div><div>Onco360 Pharmacy is seeking a <b>Pharmacy Prior Authorization Specialist</b> to join our dedicated team in New Hyde Park, NY. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.</div>
<div> </div><p></p><div><div><b>Why Join Us?</b></div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value <b>teamwork, respect, integrity, and passion</b>.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul>
</div><div></div><div><b>Company Benefits</b></div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Quarterly Incentive Bonus</li>
<li>Paid Volunteer Day</li>
<li>Referral Incentive Program</li>
<li>Company Paid Life Insurance; and Short/Long-Term Disability</li>
</ul><p></p><div><b>What You&rsquo;ll Do</b></div>
<div>The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.</div>
<div></div><div><b>How You&rsquo;ll Do This</b></div>
<ul><li>Manage prior authorization requests and appeals with insurance carriers.</li>
<li>Collaborate with physicians, pharmacists, and other departments.</li>
<li>Ensure HIPAA compliance while handling sensitive patient information.</li>
<li>Maintain accurate documentation of authorization details.</li>
<li>Proactively monitor and renew expiring authorizations.</li>
</ul> <p></p><div><b>What You Bring</b></div>
<div><b>Required:</b></div>
<ul><li>High School Diploma or GED</li>
<li>1+ years of pharmacy or prior authorization experience</li>
<li>Registration with Board of Pharmacy (as required by state law)</li>
<li>Strong communication, organizational, and customer service skills</li>
<li>Self-motivated, organized, detail-oriented, and adaptable to changing priorities</li>
<li>Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds</li>
</ul><div><b>Preferred:</b></div>
<ul><li>Associate degree or Certified Pharmacy Technician (PTCB)</li>
<li>3+ years of experience in pharmacy or prior authorizations</li>
<li>Specialty pharmacy experience</li>
</ul><p></p><div><b>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</b></div>
<div></div><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div>

Pharmacy Prior Authorization Specialist

<div><div><b>Pharmacy Prior Authorization Specialist &ndash; Onco360 Pharmacy</b><br>
<i>Scottsdale, AZ</i>| <i>Full-Time</i> | <i>Starting at $23.00/hr and up</i></div>
<div></div><div><b>Join a mission-driven team making a difference in the lives of cancer patients.</b></div>
<div></div><div>Onco360 Pharmacy is seeking a <b>Pharmacy Prior Authorization Specialist</b> to join our dedicated team in Scottsdale, AZ. This is a full-time position ideal for candidates local to the area. <b>Remote work possible after initial on-site training.</b></div><br>
<div></div>
 <p></p><div><b>Why Join Us?</b></div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value <b>teamwork, respect, integrity, and passion</b>.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul><div><b>Company Benefits</b></div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Quarterly Incentive Bonus</li>
<li>Paid Volunteer Day</li>
<li>Referral Incentive Program</li>
<li>Company Paid Life Insurance; and Short/Long-Term Disability</li>
</ul><p></p><div><b>What You&rsquo;ll Do</b></div>
<div></div><div>The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.</div>
<div></div><div><b>How You&rsquo;ll Do This</b></div>
<ul><li>Manage prior authorization requests and appeals with insurance carriers.</li>
<li>Collaborate with physicians, pharmacists, and other departments.</li>
<li>Ensure HIPAA compliance while handling sensitive patient information.</li>
<li>Maintain accurate documentation of authorization details.</li>
<li>Proactively monitor and renew expiring authorizations.</li>
</ul> <p></p><div><b>What You Bring</b></div>
<div></div><div><b><i>Required:</i></b></div>
<ul><li>High School Diploma or GED</li>
<li>1+ years of pharmacy or prior authorization experience</li>
<li>Registration with Board of Pharmacy (as required by state law)</li>
<li>Strong communication, organizational, and customer service skills</li>
<li>Self-motivated, organized, detail-oriented, and adaptable to changing priorities</li>
<li>Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds</li>
</ul><div><b>Preferred:</b></div>
<ul><li>Associate degree or Certified Pharmacy Technician (PTCB)</li>
<li>3+ years of experience in pharmacy or prior authorizations</li>
<li>Specialty pharmacy experience</li>
</ul><p></p><div><b>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</b></div>
<div></div><div><b>#Company Values: Teamwork, Respect, Integrity, Passion</b></div></div><div></div>

Amerita, Inc

<div>
 <strong>
  Our Company
  <br/>
  <br/>
 </strong>
 Amerita
 <br/>
 <br/>
 <strong>
  Overview
  <br/>
  <br/>
 </strong>
 This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process.
 <br/>
 <br/>
 Shift: Monday-Friday 8:30am-5:30pm (CST)
 <br/>
 <br/>
 <strong>
  Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines.
  </li>
  <li>
   Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions.
  </li>
  <li>
   Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols.
  </li>
  <li>
   Knowledgeable to perform all PA functions.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy
  </li>
  <li>
   1+ years pharmacy experience
  </li>
  <li>
   Pharmacy or healthcare-related knowledge
  </li>
  <li>
   Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication
  </li>
  <li>
   Basic math and analytical skills
  </li>
  <li>
   Intermediate typing/keyboard skills
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  About Our Line Of Business
  <br/>
  <br/>
 </strong>
 Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com . Follow us on Facebook , LinkedIn , and X .
 <br/>
 <br/>
 <strong>
  Additional Job Information
  <br/>
  <br/>
 </strong>
 <strong>
  Percentage of Travel:
 </strong>
 0-25%
 <br/>
 <br/>
 <strong>
  Salary Range
  <br/>
  <br/>
 </strong>
 USD $21.00 - $26.00 / Hour
</div>


Prior Authorization Specialist / Remote

Onco360 Oncology Pharmacy

<div>
 <strong>
  Pharmacy Prior Authorization Specialist &ndash; Onco360 Pharmacy
  <br/>
  <br/>
 </strong>
 <em>
  Houston, TX
 </em>
 |
 <em>
  Full-Time
 </em>
 |
 <em>
  Starting at $23.00/hr and up
  <br/>
  <br/>
 </em>
 <strong>
  Join a mission-driven team making a difference in the lives of cancer patients.
  <br/>
  <br/>
 </strong>
 Onco360 Pharmacy is seeking a
 <strong>
  Pharmacy Prior Authorization Specialist
 </strong>
 to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area.
 <strong>
  Remote work possible after initial on-site training.
  <br/>
  <br/>
 </strong>
 <strong>
  Why Join Us?
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   A career with purpose: Help patients access life-saving medications.
  </li>
  <li>
   Supportive culture: We value teamwork, respect, integrity, and passion.
  </li>
  <li>
   Growth opportunities: We invest in your professional and personal development.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Company Benefits
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Medical; Dental; Vision
  </li>
  <li>
   401k with a match
  </li>
  <li>
   Paid Time Off and Paid Holidays
  </li>
  <li>
   Tuition Reimbursement
  </li>
  <li>
   Quarterly Incentive Bonus
  </li>
  <li>
   Paid Volunteer Day
  </li>
  <li>
   Referral Incentive Program
  </li>
  <li>
   Company Paid Life Insurance; and Short/Long-Term Disability
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You&rsquo;ll Do
  <br/>
  <br/>
 </strong>
 The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
 <br/>
 <br/>
 <strong>
  How You&rsquo;ll Do This
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage prior authorization requests and appeals with insurance carriers.
  </li>
  <li>
   Collaborate with physicians, pharmacists, and other departments.
  </li>
  <li>
   Ensure HIPAA compliance while handling sensitive patient information.
  </li>
  <li>
   Maintain accurate documentation of authorization details.
  </li>
  <li>
   Proactively monitor and renew expiring authorizations.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You Bring
  <br/>
  <br/>
 </strong>
 <em>
  <strong>
   Required:
   <br/>
   <br/>
  </strong>
 </em>
 <ul>
  <li>
   High School Diploma or GED
  </li>
  <li>
   1+ years of pharmacy or prior authorization experience
  </li>
  <li>
   Registration with Board of Pharmacy (as required by state law)
  </li>
  <li>
   Strong communication, organizational, and customer service skills
  </li>
  <li>
   Self-motivated, organized, detail-oriented, and adaptable to changing priorities
  </li>
  <li>
   Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associate degree or Certified Pharmacy Technician (PTCB)
  </li>
  <li>
   3+ years of experience in pharmacy or prior authorizations
  </li>
  <li>
   Specialty pharmacy experience
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.
  <br/>
  <br/>
 </strong>
 <strong>
  #Company Values: Teamwork, Respect, Integrity, Passion
  <br/>
  <br/>
 </strong>
 #IH
</div>


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Prior Authorization Pharmacy Technician - Remote US

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