A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Medical, Dental, Vision, Paid Time Off, Paid Holidays, and 401(k) eligibility About Medcare Infusion Pharmacy Medcare Infusion Pharmacy is a leading provider of home infusion and specialty pharmacy services dedicated to delivering exceptional patient care throughout South Florida. We are seeking a highly motivated and detail-oriented Pharmacy Technician - Prior Authorization Specialist to join our growing IV Infusion Department in Hialeah. This role is ideal for an experienced Pharmacy Technician who thrives in a fast-paced environment and has a strong background in insurance verification, prior authorizations, and infusion pharmacy operations. Position Summary The Pharmacy Technician - Prior Authorization Specialist is responsible for obtaining and managing insurance authorizations for infusion therapies, specialty medications, and related pharmacy services. This position works closely with physicians, insurance companies, pharmacists, nurses, and patients to ensure timely approval of therapies and uninterrupted patient care. Key Responsibilities Submit, track, and manage prior authorization requests for IV infusion medications and specialty therapies. Verify insurance eligibility, benefits, and coverage requirements. Review physician orders and supporting clinical documentation for completeness and accuracy. Communicate with insurance carriers, physician offices, patients, and healthcare providers regarding authorization status and requirements. Follow up on pending authorizations and resolve denials, appeals, and reimbursement issues. Maintain accurate documentation of all authorization activities within pharmacy software systems. Collaborate with pharmacists, intake coordinators, nurses, and revenue cycle staff to facilitate timely patient care. Monitor authorization expiration dates and obtain reauthorizations as needed. Stay current on payer policies, infusion therapy requirements, and reimbursement guidelines. Ensure compliance with HIPAA, Medicare, Medicaid, and all applicable state and federal regulations. Provide exceptional customer service to patients and referral sources.
Qualifications Required:
Active Florida Pharmacy Technician Registration. High School Diploma or GED. Minimum of 2 years of experience in prior authorizations, insurance verification, or specialty pharmacy operations. Experience working with commercial insurance, Medicare, Medicaid, and managed care plans. Strong knowledge of medical and pharmacy terminology. Excellent organizational, communication, and multitasking skills. Proficiency with Microsoft Office and pharmacy management software.
Preferred:
Experience in an IV infusion, specialty pharmacy, oncology, biologics, or home infusion setting. Bilingual English and Spanish. Knowledge of infusion medication reimbursement and appeals processes. Why Join Medcare Infusion Pharmacy? ✔
Competitive Pay:
$25-$27 per hour ✔ Comprehensive Benefits Package ✔ Stable Monday-Friday Schedule ✔ Growth Opportunities within a rapidly expanding organization ✔ Collaborative and Supportive Team Environment ✔ Opportunity to make a direct impact on patient care and outcomes Apply Today! If you are an experienced Pharmacy Technician with a passion for helping patients gain access to critical infusion therapies, we encourage you to apply and become part of the Medcare Infusion Pharmacy team. Medcare Infusion Pharmacy Hialeah, Florida Delivering Excellence in Infusion Care, One Patient at a Time.
Pay:
$25.00 - $27.00 per hour
Benefits:
401(k) Dental insurance Health insurance Paid time off Application Question(s): Are you a registered Pharmacy Technician through the state of Florida? Are you bilingual English and Spanish? Do you have prior authorization experience?
