Pharmacy Technician - Specialty Pharmacy (Prior Authorizations & Customer Servic

The Pharmacy Technician in Specialty Pharmacy is responsible for performing prior authorization processes, managing customer service calls, and collaborating with healthcare providers and patients to ensure the timely and accurate delivery of specialty medications. This position also involves verifying patient insurance, collecting copays, and providing excellent customer support to patients and healthcare teams.

Key Responsibilities:

1. Prior Authorization Management:
   • Initiate and manage the prior authorization (PA) process for specialty medications.
   • Communicate with insurance companies, physicians, and healthcare providers to gather necessary documentation for PA approval.
   • Track and follow up on pending authorizations to ensure timely resolution.
   • Provide updates to patients and healthcare providers regarding PA status.
2. Customer Service & Patient Support:
   • Answer incoming calls from patients, healthcare providers, and insurance companies with professionalism and efficiency.
   • Educate patients and providers about medication coverage, insurance requirements, and specialty pharmacy services.
   • Address inquiries related to prescription refills, insurance issues, medication availability, and copay collection.
   • Assist patients in navigating the insurance process and clarify any questions about co-pays, deductibles, and out-of-pocket costs.
3. Copay Collection & Billing:
   • Collect copayments from patients, ensuring accurate recording and reporting of payment information.
   • Verify insurance benefits and provide accurate cost estimates to patients.
   • Coordinate with financial assistance programs, patient assistance programs (PAP), or co-pay cards when applicable.
   • Assist with claims processing and resolve any issues with billing or payment discrepancies.
4. Collaboration with Healthcare Providers:
   • Communicate effectively with physicians' offices, healthcare providers, and clinical staff to ensure all necessary documentation is received and processed for medication approvals.
   • Provide feedback to physicians' offices regarding documentation gaps and follow up to expedite the approval process.
5. Compliance & Documentation:
   • Ensure all patient interactions, authorizations, copay transactions, and other related activities comply with HIPAA regulations, pharmacy policies, and state/federal laws.
   • Maintain accurate and up-to-date patient records in the pharmacy’s management system.
   • Participate in regular audits and quality assurance processes to ensure compliance with internal and external standards.
6. Team Collaboration:
   • Work collaboratively with pharmacists, other pharmacy technicians, and customer service staff to ensure the efficient and effective operation of the pharmacy.
   • Participate in staff meetings and training sessions to stay up-to-date with changes in medication therapies, insurance policies, and regulatory guidelines.

Job Requirements:

Education and Experience:

• High school diploma or equivalent required; Pharmacy Technician Certification (CPhT) preferred.
• Prior experience working in a pharmacy, preferably in a specialty pharmacy setting.
• Knowledge of specialty medications, insurance verification, and the prior authorization process.
• Customer service experience, especially in a healthcare setting, is highly preferred.

Skills and Abilities:

• Strong knowledge of pharmaceutical terminology and medical insurance procedures.
• Excellent communication skills, both written and verbal, with a focus on customer service.
• Ability to navigate electronic health records (EHR) systems and pharmacy management software.
• Detail-oriented with strong organizational and multitasking abilities.
• Problem-solving skills, especially when addressing insurance, billing, or medication access issues.
• Ability to work independently as well as part of a team.
• Knowledge of HIPAA regulations and confidentiality standards.

Additional Requirements:

• Ability to handle high-volume calls in a professional and courteous manner.
• Strong computer skills, including proficiency with Microsoft Office Suite and pharmacy management software.
• Ability to handle sensitive patient information with discretion and confidentiality.
• Must be able to work in a fast-paced environment with competing priorities and deadlines.

Physical Requirements:

• Ability to sit or stand for extended periods of time.
• Occasional lifting of up to 20 lbs.

Preferred Qualifications:

• Pharmacy Technician Certification (CPhT) or equivalent.
• Previous experience in a specialty pharmacy or healthcare-related setting.
• Bilingual abilities (Spanish or other languages) are a plus.

This role is vital to ensuring that patients receive the appropriate medications in a timely manner and that all associated processes, including insurance verification and copay collection, are handled efficiently and accurately. The successful candidate will have a strong customer-focused attitude, attention to detail, and a thorough understanding of the pharmacy workflow and insurance procedures.