Prior Authorization Technician

Summary

Join Shields Health Solutions as a Patient Support Advocate and make a difference in patients' lives daily! This role focuses on removing barriers to medication access by working with insurance companies and clinicians to facilitate medication approvals and financial assistance. You will provide phone support to patients, navigating pharmacy systems to adjudicate claims and improve medication adherence. The position requires strong communication and problem-solving skills, along with experience as a pharmacy technician. Shields offers a supportive and inclusive work environment, recognized as a Great Place to Work.

Requirements

• Be a state registered, or state certified as a pharmacy technician
• Have 1+ years of experience as a Pharmacy Technician
• Possess a High school diploma or GED

Responsibilities

• 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

Preferred Qualifications

Be nationally certified as a CPhT or equivalent