Prior Authorization Technician (MUST HAVE 2+ YEARS IN PBM OR ADJACENT)

Position Summary

The Prior Authorization (PA) Technician supports the medication utilization review process by assisting with the intake, evaluation, and coordination of prior authorization requests. This role works closely with healthcare providers, pharmacies, members, and internal teams to ensure timely, accurate processing of medication requests in accordance with plan guidelines, regulatory requirements, and DisclosedRx service standards.

This position requires exceptional attention to detail, strong communication skills, and the ability to manage multiple priorities in a fast-paced environment. The PA Technician plays a key role in supporting member access to appropriate medications while upholding the company's commitment to transparency, integrity, and superior service.

Job Responsibilities

To perform this job successfully, an individual must be able to perform each essential function satisfactorily.

Evaluates prior authorization requests and determines coverage eligibility based on plan guidelines and clinical criteria.

Collaborates with healthcare providers and pharmacies to obtain necessary documentation, clarify prescription needs, and support accurate review.

Initiates prior authorization renewals and conducts ongoing outreach to obtain required information.

Communicates prior authorization decisions-including approvals, denials, and follow-up needs-to providers, pharmacies, and members.

Maintains accurate records of request status, documentation, determinations, and follow-up actions in internal systems.

Assists with appeals, reconsiderations, and additional review processes as needed.

Identifies workflow or process improvement opportunities to enhance efficiency and service quality.

Ensures compliance with all regulatory requirements, plan policies, and internal procedures related to prior authorization operations.

Supports internal clinical and operational teams by providing timely updates, information, and administrative support related to PA workflows.

Performs other duties as assigned or requested. Any one position may not include all the duties listed; these duties represent the key responsibilities typically associated with this role.

Required Experience

High school diploma or equivalent.

1+ years of experience in a pharmacy, PBM, or healthcare-related setting.

Knowledge of prior authorization processes and insurance benefit guidelines.

Strong attention to detail, organizational skills, and accuracy in documentation.

Excellent communication and problem-solving abilities.

Ability to manage multiple priorities and deadlines in a fast-paced environment.

Preferred Qualifications

Active, unrestricted pharmacy technician license (or eligibility to obtain).

2+ years of experience in a pharmacy, PBM, or managed care setting.

Familiarity with pharmacy claims processing, PA platforms, and formulary structures.

Demonstrated ability to collaborate effectively with internal and external stakeholders.