Remote Prior Authorization Pharmacy Tech

Job Description

Job Description

Job Responsibilities:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily.

• Evaluates prior authorization requests and determines coverage eligibility based on plan guidelines and clinical criteria.
• Collaborates with healthcare providers and pharmacies to obtain necessary documentation, clarify prescription needs, and support accurate review.
• Initiates prior authorization renewals and conducts ongoing outreach to obtain required information.
• Communicates prior authorization decisions-including approvals, denials, and follow-up needs-to providers, pharmacies, and members.
• Maintains accurate records of request status, documentation, determinations, and follow-up actions in internal systems.
• Assists with appeals, reconsiderations, and additional review processes as needed.
• Identifies workflow or process improvement opportunities to enhance efficiency and service quality.
• Ensures compliance with all regulatory requirements, plan policies, and internal procedures related to prior authorization operations.
• Supports internal clinical and operational teams by providing timely updates, information, and administrative support related to PA workflows.
• Performs other duties as assigned or requested. Any one position may not include all the duties listed; these duties represent the key responsibilities typically associated with this role.

Required Experience:

• Experience in PBM, PBM Adjacent, Health Plan or pharmacy-related setting.
• Knowledge of prior authorization processes and insurance benefit guidelines.
• Strong attention to detail, organizational skills, and accuracy in documentation.
• Excellent communication and problem-solving abilities.
• Ability to manage multiple priorities and deadlines in a fast-paced environment.
• Active pharmacy technician license

Preferred Qualifications:

• Familiarity with pharmacy claims processing, PA platforms, and formulary structures.
• Demonstrated ability to collaborate effectively with internal and external stakeholders.
• Pharmacy Technician Certification

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?