Prior Authorization Technician – Pharmacy Technician

🕒 May 12

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Shields Health Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2011

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

Healthcare Insurance • Pharmaceuticals • SaaS

Shields Health Solutions is a company that specializes in providing integrated specialty pharmacy solutions. They focus on eliminating disruptions in patient care by offering a comprehensive model that bridges the gap between patients and the specialty medications they need. Shields Health Solutions partners with healthcare providers and drug manufacturers to optimize the impact of specialty pharmacy services. Their approach leverages a clinical model, expert care teams, and a proprietary technology platform to improve patient access to specialty drugs, while reducing the overall cost of care. Shields Health Solutions aims to enhance patient experiences and health outcomes through their innovative solutions in specialty pharmacy integration.

📋 Description

• Provide patient care by removing the barriers to medication access • Work with insurance companies and clinician offices to facilitate approval of medications through prior authorizations • Provide phone support to patients by navigating pharmacy dispensing systems to adjudicate claims, refill medications, and increase adherence in patients • Directly communicate with insurance companies to facilitate the approval of medications • Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up • Effectively communicate across databases, electronic medical records and emails to document patient concerns, prior authorization status, and financial assistance needs • Review prescriptions with doctors' offices to ensure optimal care of the patient • Keep complete and accurate records of patient communications • Assist patients in the management of their pharmacy insurance claims • Work closely with pharmacists and pharmacy liaisons to provide an integrated approach quality patient care • Communicate directly with patients over the phone to assist them in all aspects of medication compliance • Research and investigate information to enable strategic decision-making by others • Manage, organize, and update relevant data using database applications • Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards • Identify trends, resolve problems; recommend improvements; implement change • Actively participate in process improvement initiatives • Act as a value-added business partner to stakeholders throughout the organization • Protect organization's value by keeping information confidential • Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations • Minimal in or out of state travel may be required • Perform other duties as assigned

🎯 Requirements

• 1+ years as a Pharmacy Technician • State registered or state certified as a pharmacy technician • Nationally certified as a CPhT or equivalent is strongly preferred but not required • High school diploma or GED required

🏖️ Benefits

• Health insurance • Flexible work hours • Professional development opportunities