Pharmacy Technician - Outpatient - PTO26-07202

Job Description

Job Description

Pharmacy Technician – Outpatient

Location: Portland, Oregon

Duration: 26 Weeks

Schedule
• Standard Business Hours
• On-Call Coverage: Approximately 2–3 weekends per year

Pay Rate: $33 - $37 per hour (Depending on Experience)

Position Overview

"Navitas Healthcare, LLC" is seeking an experienced Pharmacy Technician to support pharmacy operations, pharmacy benefit administration, and prior authorization processes within a managed care environment. The ideal candidate will possess strong pharmacy benefit management experience, prior authorization expertise, advanced analytical skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.

Key Responsibilities

Prior Authorization & Pharmacy Benefits Administration

• Process and coordinate pharmacy prior authorization requests according to benefit policies and utilization management guidelines.
• Review authorization requests, supporting documentation, and medication utilization criteria.
• Escalate complex cases to Clinical Pharmacists or Medical Directors when necessary.
• Communicate authorization decisions and medication requirements to providers and prescribers.

Pharmacy Operations & Claims Processing

• Support pharmacy benefit administration and pharmacy network operations.
• Monitor pharmacy claims transactions and eligibility processes.
• Research and resolve pended claims, reimbursement requests, and authorization issues.
• Process pharmacy claims payments and Direct Member Reimbursements (DMRs).
• Audit pharmacy claims and documentation for accuracy and compliance.

Member & Provider Support

• Provide exceptional customer service to members, providers, and pharmacies.
• Respond to inquiries regarding pharmacy benefits, claims, and prior authorizations.
• Resolve complex benefit and medication-related issues.

Data Management & Reporting

• Maintain pharmacy databases and member eligibility information.
• Analyze operational and clinical data using advanced Excel functions.
• Develop reports to support quality improvement and operational performance.

Coding & Clinical Support

• Apply ICD-10, CPT, HCPCS, and pharmacy coding knowledge to support claims and authorization reviews.
• Assist with documentation review and coding validation.

Training & Process Improvement

• Train staff and providers on pharmacy processes and systems.
• Develop workflow documentation and job aids.
• Participate in process improvement and quality initiatives.

Compliance & Regulatory Responsibilities

• Maintain compliance with HIPAA, pharmacy regulations, and health plan requirements.
• Monitor for fraud, waste, and abuse concerns.
• Support audits and regulatory reviews as needed.

Required Qualifications

• Active Oregon Pharmacy Technician License.
• Minimum 2 years of Pharmacy Technician experience in a managed care environment.
• Experience handling pharmacy prior authorization reviews.
• Experience within managed care, health plan operations, PBM, or utilization management environments.
• Advanced Microsoft Excel skills.
• Strong knowledge of pharmacy benefits, claims processing, reimbursement, and utilization management.
• Excellent analytical, organizational, communication, and customer service skills.

Preferred Qualifications

• Bachelor's Degree.
• Experience with Medicare, Medicaid, Commercial, Individual, and ASO audits.
• Experience processing pharmacy claims and benefit determinations.

For more details contact at View email address on ziprecruiter.com or Call / Text at View phone number on ziprecruiter.com.

About Navitas Healthcare, LLC:
It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.