Prior Authorization Technician I

Duties:
The Prior Authorization Technician I assists in the prior authorization process.
Reports directly to the Supervisor, Prior Authorization Technicians
Processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications
Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable
Utilizes member claims history during the prior authorization review process
Makes outbound calls to obtain additional information needed to process prior authorization requests
Submits authorizations to pharmacy and medical claims processors
Forwards prior authorization requests to a pharmacist when necessary
Makes appropriate referrals to other clinical programs
Assists in directing appropriate requests to in network providers
Receives inbound calls from the customer care center with prior authorization related inquiries
Assist with Appeals processing as assigned
Ability to multitask between various tasks and systems while maintaining required productivity and quality levels
Ability to make changes in a fast paced environment
Strong knowledge of specialty and non-specialty pharmaceuticals
Performs other job related duties and projects as assigned
Attends required training on an annual basis.
Adheres to corporate and departmental policies and procedures.
Available to work weekends and holidays.

Education:
High School Diploma / GED
Certified Pharmacy Technician (PTCB or NHA) Required

Skills:
1 to 3 Years
Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
Minimum 35 words per minute typing speed.

City: Philadelphia

Schedule:
Start Date: 12/15/2025
End Date: 03/15/2026
Hours Per Week: 40.00
Hours Per Day: 8.00
Days Per Week: 5.00