Job Title: Pharmacy Technician

Job Description

This role focuses on managing end-to-end prior authorization and insurance verification processes for specialty medications, ensuring patients gain timely access to therapy while receiving accurate, high-quality support. You will work in a hybrid office and remote environment, handling detailed pharmacy and insurance tasks, communicating with patients and healthcare providers, and supporting a rapidly growing specialty pharmacy operation dedicated to improving outcomes for individuals with rare and complex diseases.

Responsibilities

• Recognize and clearly communicate different insurance types and explain when each type should be utilized for patient coverage.
• Communicate with patients to gather complete and accurate insurance information needed for prior authorizations and claims processing.
• Enter all communication, documentation, and case updates into the Biologics MIS system in a timely and accurate manner.
• Appropriately process pharmacy claims in the Biologics MIS and interpret pharmacy claim responses to determine next steps.
• Triage prescriptions to preferred pharmacies or HUB providers when the specialty pharmacy is unable to serve the patient, ensuring continuity of care.
• Manage inbound calls from patients, clients, physicians, and payors regarding patient updates, prior authorization status, and services provided.
• Conduct significant outbound calling to patients, clinics, and insurance providers to initiate, follow up on, and complete prior authorizations.
• Review clinic notes and large medical records, often 90 or more pages, to identify required documentation that meets payer requirements.
• Work closely with CoverMyMeds and insurance providers to submit, track, and resolve prior authorization requests.
• Identify and report adverse events and product complaints to clinicians according to established procedures.
• Manage and respond to internal written communications and requests received via chat or email in a professional and timely manner.
• Assist with projects such as yearly reverification and other operational initiatives related to patient access and insurance coverage.
• Navigate patient cases and proactively resolve barriers to treatment, exploring all available options before accepting a denial.
• Meet productivity expectations by managing approximately 16–20 patient cases per day while maintaining high accuracy and attention to detail.
• Perform other related duties as assigned by the supervisor to support the overall operations of the specialty pharmacy.

Essential Skills

• Prior authorization experience in a hospital, specialty pharmacy, physician office, or healthcare setting is highly preferred.
• Strong pharmacy experience in pharmacy services and workflows.
• Hands-on experience with insurance verification and understanding of payer requirements.
• Knowledge of medical billing and coding principles relevant to pharmacy claims and prior authorizations.
• Ability to review and interpret clinic notes and extensive medical records to extract necessary documentation.
• Comfort working with complex, detail-oriented, and time-intensive processes related to prior authorizations.
• Proficiency in managing both inbound and outbound calls with patients, clinics, and insurance providers.
• Ability to recognize and understand pharmacy claim responses and determine appropriate follow-up actions.
• Strong documentation skills, including accurate data entry into systems such as Biologics MIS.
• Persistence and resourcefulness, with a willingness to explore all options before accepting a negative outcome.
• Ability to navigate patient cases and resolve barriers to treatment with a patient-centered approach.
• Capacity to work independently in a hybrid environment while meeting productivity expectations of 16–20 patients per day.

Additional Skills & Qualifications

• Prior authorizations experience in a hospital, specialty pharmacy, or healthcare setting is strongly preferred.
• Medical Assistant experience is considered a strong plus.
• Registered Pharmacy Technician status is nice to have.
• Certified Pharmacy Technician (CPhT) credential is a plus.
• Experience working with CoverMyMeds or similar prior authorization platforms.
• experience in medical billing and coding and pharmacy services.
• Comfort working with large volumes of medical documentation and multitasking in a fast-paced environment.
• Strong communication skills for interacting with patients, clinicians, payors, and internal teams.
• Ability to collaborate within a