Prior Authorization Systems Technician
United StatesFull-TimeMiddle
Salary75,000 - 80,000 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.
- National Certified Pharmacy Technician (CPhT) certification.
- Demonstrated experience working with prior authorization systems, UM criteria, or clinical rule configuration.
- Strong understanding of prior authorization workflows, clinical guidelines, and formulary management.
- High attention to detail with a focus on data accuracy and configuration quality.
- Proficiency in Microsoft Excel and Word for data analysis and tracking.
- Ability to troubleshoot system issues and communicate with technical stakeholders.
- Experience supporting system testing (UAT, regression, or validation) preferred.
- Experience creating or maintaining prior authorization decision trees strongly preferred.
- Bachelor’s degree or equivalent combination of education and experience preferred.
Responsibilities
- Evaluate and operationalize weekly formulary and utilization management (UM) updates.
- Maintain and configure prior authorization (PA) criteria, rules, and documentation within the PA platform.
- Perform structured validation and quality assurance (QA) of criteria builds, letter templates, and system configurations.
- Support new drug-to-market implementations, including GPI and NDC analysis.
- Act as a subject matter resource for PA criteria setup and internal troubleshooting.
- Collaborate with Clinical, Operations, and IT teams to support system improvements and workflow automation.
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