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.
Pharmacy Technician Prior Authorization Specialist - Infusion Services Trinity Health Michigan - 3.2 Grand Rapids, MI Job Details Full-time 17 hours ago Qualifications Medicare High school diploma or GED Medicaid health insurance Medicaid Medical terminology
Full Job Description Employment Type:
Full time
Shift:
Day Shift Description:
Schedule |
Hours:
Full-time, 40 hours per week
Days Monday-Friday Position Summary:
The Prior Authorization Technician supports medication access by coordinating prior authorization (PA) requests, benefit investigations, and MSOT workflows within the Epic electronic health record. This role provides high-quality support to providers, office staff, and patients across multiple ambulatory clinics. The technician manages complex insurance requirements and serves as the primary point of contact for PA-related needs. What you'll do: Prior authorization coordination Review payer requirements, gather necessary clinical information, submit complete PA requests through payer portals, fax, or phone, and coordinate appeal submissions when necessary. MSOT workflow management Process Multi-Step Order Transmittal tasks, ensure accurate internal routing, resolve workflow barriers, and communicate order status to clinic teams. Provider and office staff support Respond to PA-related questions from prescribers and clinic staff. Request additional documentation when needed. Communicate approvals, denials, and alternative therapy requirements. Patient communication Provide updates on PA status, expected timelines, and next steps; assist with understanding insurance requirements. Insurance benefit investigation Verify coverage, copays, step therapy rules, and formulary alternatives. Documentation in Epic Maintain accurate, timely notes in Epic, including PA status, payer communication, and MSOT task completion. Navigate denials, identify alternative pathways, and escalate only when clinical review is required. Ensure PA and MSOT tasks are completed efficiently and routed appropriately to support clinic operations. Prioritize and manage multiple concurrent PA and MSOT requests while meeting established turnaround time expectations. What you'll need: High school education or equivalent. Licensed as a Pharmacy Technician or Pharmacist Intern in the State of Michigan. 1 year Pharmacy Tech Work experience. Understanding of commercial, Medicare, and Medicaid insurance plans. Familiarity with medical terminology, diagnosis codes, and PA criteria.
Preferred:
Proficiency with Epic and payer portals.
Preferred:
Experience with prior authorizations, insurance billing, or ambulatory pharmacy workflows.
Preferred:
Completion of a formal Pharmacy Technician training program; or two years of college with emphasis in math, science, or medical field applications.
Preferred:
Active status as a Certified Pharmacy Technician (CPhT) by the Pharmacy Technician Certification Board (PTCB) Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
