Prior Authorization Tech 1
Prior Authorization Technician I – Job Description Position Summary The Prior Authorization Technician I (PA Tech I) provides non-clinical administrative and customer support related to prior authorization requests, pharmacy benefit inquiries, and override requests. This role serves providers, pharmacies, members, and internal departments to help ensure timely access to medications while maintaining compliance and service standards. Essential Duties and Responsibilities
- Process and manage Level 1 (administrative) prior authorization requests.
- Handle incoming calls and requests from providers, pharmacies, members, and internal departments.
- Research and resolve pharmacy benefit and claim-related i
- Process override requests, including vacation overrides, lost/stolen medication overrides, and refill-too-soon requests as permitted.
- Review and document information in PA Hub, RxClaim, ServiceNow, and other applicable systems.
- Verify prior authorization status, prescriber information, clinical documentation receipt, and determination communications.
- Maintain accurate documentation and comply with established policies, procedures, and quality standards.
- Provide professional and empathetic customer service while managing escalated situations appropriately.
- Assist with overflow Pharmacy Help Desk and Member Services support as needed.
Knowledge, Skills, and Abilities
- Strong customer service and communication skills.
- Ability to multitask and work in a fast-paced environment.
- Attention to detail and commitment to accuracy.
- Problem-solving, organization, and time-management skills.
- Ability to learn and use systems such as RxClaim, PA Hub, ServiceNow, Microsoft Office, and internal knowledge resources.
- Understanding of pharmacy benefits, prior authorization workflows, and HIPAA requirements preferred.
- High school diploma or equivalent.
- Customer service, call center, healthcare, pharmacy, or PBM experience preferred.
- Ability to meet productivity, quality, and attendance expectations.
Work Environment
- High-volume, member-focused environment supporting approximately 7,000 calls and 4,000 requests monthly across multiple stakeholder groups.