Pharmacy Prior Authorization Technician - Diabetes and Endocrinology

Description

Professional - Clinical
Req #: 68440

(Eligible for $3,000 Sign on Bonus paid out in three installments, prorated for Part Time) Current MaineHealth employees not eligible for the sign on bonus. Must be separated from MaineHealth system for 6 months to be eligible.

Summary:

The Pharmacy Prior Authorization Technician is responsible for coordinating and processing prior authorizations (PAs) for prescription medications to ensure timely patient access to treatment. Working closely with providers, pharmacists, payers, and patients, the technician utilizes the EHR and payer portals to facilitate and document the PA process.

This role is key to supporting the clinical team in minimizing treatment delays and improving medication access. The role will initially be focused on prior authorizations for our MaineHealth Diabetes and Endocrinology practices, but this could expand.

Key Responsibilities:

*Review medication orders (especially specialty medications) needing prior authorization.

*Initiate and complete prior authorization requests through electronic portals (e.g., CoverMyMeds, Surescripts, payer websites).

*Communicate with insurance companies to gather coverage requirements and status updates.

*Collaborate with providers and pharmacists to obtain necessary clinical documentation for PA submissions.

*Document PA status, approvals, denials, and follow-ups within Epic using SmartPhrases and encounters.

*Notify providers of PA outcomes and assist with alternative medication strategies when necessary.

*Track and manage open prior authorizations to ensure timely resolution and refill coordination.

*Support clinic staff and patients by providing status updates or coverage information as allowed.

*Maintain up-to-date knowledge of payer formulary changes and authorization requirements.

*Participate in continuous quality improvement and workflow optimization efforts.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: High school diploma or equivalent required.
2. License/Certifications: Current or eligible for applicable state(s) license as a Pharmacy Technician. CPhT certification is required.
3. Experience: One year of experience as a licensed pharmacy technician.
4. Additional Skills/Requirements Required: N/A
5. Additional Skills/Requirements Preferred: N/A

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Additional Information

If you have questions about this role, please contact brandon.drinkwater@mainehealth.org