Job at a glance
Job Title: Pharmacy Technician – Coverage Determinations Job Description This role focuses on tracking, reviewing, and processing coverage determination requests for prior authorizations and Medicare Part D recipients. The pharmacy technician evaluates requests against defined criteria, coordinates with prescribers to obtain necessary clinical information, and ensures accurate documentation and communication of decisions within the pharmacy benefit management (PBM) system.
Responsibilities Track and triage coverage determination requests submitted by providers and determine when a pharmacist review is required. Obtain verbal authorizations from prescribers and request detailed clinical information to support coverage determination decisions. Approve coverage determination requests based on established and clearly defined criteria. Enter and document coverage determination decisions accurately in the PBM system.
Notify providers and members of coverage determination outcomes in a timely and professional manner. Respond to client inquiries related to authorization approvals and PBM online processes. Refer coverage determination requests for specialty medications to the appropriate delegated vendor or client for processing. Contact providers to obtain additional information needed to complete coverage determination reviews.
Communicate coverage determination decisions clearly to physicians, providers, and members. Essential Skills High school diploma or equivalent. At least 1 year of experience in a retail, hospital, or mail order pharmacy setting. Current state pharmacy technician license. Strong understanding of pharmacy operations, including prior authorization workflows. Ability to interpret and apply defined clinical and coverage criteria.
Proficiency in documenting decisions and activities within pharmacy or PBM systems. Clear and professional verbal communication skills for interacting with prescribers, providers, and members. Attention to detail and accuracy when tracking, triaging, and documenting coverage determination requests. Additional Skills & Qualifications National Certification from the Pharmacy Technician Certification Board (CPhT) is preferred.
Experience handling prior authorization requests in a PBM or health plan environment is beneficial. Familiarity with Medicare Part D coverage rules and processes is an advantage. Ability to manage multiple requests and inquiries in a fast-paced setting. Strong customer service skills when responding to client and provider inquiries. Work Environment The role operates within a pharmacy benefit management and prior authorization environment, working extensively with PBM systems and online tools to process coverage determinations.
The position involves frequent phone and electronic communication with prescribers, providers, clients, and members, requiring a professional and service-oriented approach. Work hours and specific shifts may vary by facility, and the setting is typically office-based with standard professional attire. Job Type & Location This is a Contract position based out of New Orleans, LA. Pay and Benefits The pay range for this position is $20.00 - $23.00/hr.
Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms.
If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spen