Prior Authorization Systems Technician
New
J
Judi HealthHealth Technology
Remote (For Non-Local) or Hybrid (Local to New York, NY, Charlotte, NC or Denver, CO area)Full-TimeMiddle
Salary78,400 - 90,000 USD per year
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Job Details
- Experience
- 4+ years of pharmacy technician experience
- Required Skills
- Microsoft ExcelQuality Assurance
Requirements
- 4+ years of pharmacy technician experience in a PBM, health plan, or clinical pharmacy environment.
- Demonstrated experience working with prior authorization systems, UM criteria, or clinical rule configuration.
- National Certified Pharmacy Technician (CPhT) certification.
- Strong understanding of prior authorization workflows, clinical guidelines, and formulary management.
- High attention to detail with a focus on data accuracy and configuration quality.
- Ability to troubleshoot system or workflow issues and communicate clearly with stakeholders.
- Proficiency in Microsoft Excel and Word for data analysis and tracking.
- Experience with system testing like UAT or regression validation preferred.
- Experience working cross-functionally with clinical, operational, or IT teams.
- Bachelor’s degree or equivalent combination of education and experience preferred.
Responsibilities
- Evaluate and operationalize weekly formulary and utilization management updates.
- Maintain and configure prior authorization criteria, rules, and documentation.
- Perform structured validation and quality assurance of criteria builds and templates.
- Partner with Formulary Operations and Clinical teams to resolve discrepancies in logic or documentation.
- Support new drug-to-market implementations including analysis of product identifiers.
- Maintain and enhance letter templates and automated communications.
- Execute batch load testing, regression testing, and release validation.
- Triage system or configuration issues and escalate to technical teams.
- Conduct intake and preparation of PA cases by validating clinical information.
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