Pharmacy Prior Authorization Technician

Position: Pharmacy Prior Authorization Technician

Rate: $21.50/hr
Location: Remote – Must reside near Buffalo, Rochester, Utica and Syracuse in New York

Summary:

The Pharmacy Prior Authorization Technician performs initial-level reviews of pharmacy and medical specialty drug prior authorization requests using established drug policies and UM procedures. This role prepares and interprets cases for utilization management reviews, supports accurate benefit interpretation, and serves as the subject matter expert for systems and workflows used in the prior authorization process. The Technician provides guidance to internal teams, assists providers and pharmacies, and ensures compliance with required timelines.

Essential Responsibilities:

• Conduct initial medication prior authorization, exception, and medical necessity reviews to determine coverage under the member’s benefit plan.
• Route cases to the pharmacist or medical director for final determinations as appropriate.
• Issue required verbal/written member notifications.
• Review prescription and medical benefit coverage across all lines of business, including Medicare Part D, and document key clinical details for reviewers.
• Assist clinical staff by identifying nuances and missing information relevant to case decisions.
• Communicate with pharmacies and provider offices to clarify request information and ensure accurate processing.
• Serve as lead resource for pharmacy help desk, customer care, and claims teams to resolve prior authorization and claims coordination issues.
• Ensure accurate authorization entry and validate interfaces with claims processing systems.
• Perform system testing related to upgrades or enhancements.
• Act as subject matter expert for pharmacy and medical drug authorizations and intake workflows.
• Triage daily workloads, monitor queues, and escalate time-sensitive cases to ensure compliance.
• Provide phone support for UM-related inquiries, offering timely and accurate assistance.
• Support drug pricing inquiries using appropriate reference tools.
• Maintain thorough knowledge of contracts, policies, procedures, and eligibility guidelines.
• Track and report department performance metrics as needed.
• Prepare and review correspondence, ensuring accuracy and timeliness.
• Collaborate with departments such as UM, QM, and Case Management to support consistent care delivery.
• Meet or exceed team productivity standards.
• Adhere to corporate values, privacy standards, policies, and attendance expectations.
• Perform other duties as assigned.

Minimum Qualifications:

• High school diploma and at least 2 years of experience in a health-related field; Associate degree preferred.
• Pharmacy Technician Certification (CPhT), LPN, or Medical Assistant/Technologist background strongly preferred.

Physical Requirements:

• Ability to sit and work at a computer for extended periods.
• Ability to work in a home-office environment as required.
• Ability to travel within the health plan service area for meetings or training.
• Ability to hear, speak, and use a phone clearly with or without a headset.

Job Type: Contract

Pay: From $21.50 per hour

Expected hours: 40 per week

Benefits:

• Referral program

Experience:

• Pharmacy technician: 2 years (Required)
• Prior Authorization: 1 year (Preferred)

License/Certification:

• Pharmacy Technician License (Required)

Work Location: Remote

Salary : $22