Specialty Pharmacy PA Technician

Key Responsibilities Prior Authorization Submission:

Initiate and manage the PA process, including submitting clinical data and managing approvals/denials for specialty drugs.

Insurance Verification:

Perform benefits investigations (BI) to determine coverage limitations and patient cost-sharing.

Clinical Communication:

Collaborate with prescribers to obtain necessary medical documentation, such as chart notes, labs, and diagnostic results.

Appeals Management:

Draft and submit clinical appeal letters for denied claims to insurers.

Financial Assistance Coordination:

Identify and apply for patient assistance programs, manufacturer hubs, and copay foundations.

Documentation & Reporting:

Maintain detailed records in electronic medical records (EMR) and track metrics on denials, turnaround times, and approvals.

Required Skills and Qualifications Experience:

Previous pharmacy technician, medical billing, or insurance experience, often with a focus on specialty therapeutics, 3-5 years experience

Knowledge:

Familiarity with medical terminology, ICD-10/CPT codes, and Medicare/Medicaid regulations, Digital RX software

Communication:

Strong verbal and written skills for effective communication with insurance representatives and clinical staff.

Technical Proficiency:

Competency with EMR systems and

Microsoft Office Pay:

$30.00 per hour

Experience:

Prior Authorization:

3 years (Required)

Digital Rx Software:

1 year (Preferred)

Work Location:

In person