About the Company
Change Healthcare (now part of Optum, a UnitedHealth Group company) is a leading provider of data and analytics-driven solutions that improve clinical, financial, administrative, and consumer engagement outcomes in healthcare. We leverage cutting-edge SaaS platforms to streamline complex processes and deliver actionable insights, transforming the healthcare industry. Our New Port Richey office is a hub for innovation and operational excellence.
Job Description
We are seeking a dedicated Prior Authorization Pharmacy Technician with a strong focus on SaaS platform utilization to join our dynamic team in New Port Richey, Florida. In this hybrid role, you will play a crucial part in facilitating timely patient access to necessary medications by efficiently managing prior authorization requests through our advanced proprietary software solutions. This position requires meticulous attention to detail, excellent communication skills, and a proactive approach to problem-solving within a fast-paced healthcare technology environment. You will be instrumental in ensuring compliance, reducing administrative burdens, and optimizing workflow efficiencies for healthcare providers.
Key Responsibilities
- Process prior authorization requests for prescription medications using our cloud-based SaaS platform.
- Communicate effectively with healthcare providers, insurance companies, and patients to gather and convey necessary information for prior authorization approvals.
- Review and interpret patient clinical information, pharmacy claims data, and payer-specific criteria to support authorization requests.
- Document all interactions and actions accurately within the designated software system, ensuring data integrity and compliance.
- Resolve prior authorization denials by initiating appeals or seeking alternative solutions, leveraging platform tools and resources.
- Stay current with evolving payer requirements, medication guidelines, and regulatory changes impacting prior authorizations.
- Collaborate with pharmacists, prescribers, and other healthcare professionals to expedite approval processes.
- Identify and implement opportunities for process improvement within the prior authorization workflow, particularly related to SaaS platform functionality.
Required Skills
- Certified Pharmacy Technician (CPhT) status
- Minimum 2 years of experience as a Pharmacy Technician, with specific experience in prior authorizations
- Proficiency in using healthcare-specific software or SaaS platforms for administrative tasks
- Strong understanding of medical terminology, drug names, and pharmacy operations
- Excellent verbal and written communication skills
- Exceptional organizational skills and attention to detail
- Ability to work independently and as part of a team in a fast-paced environment
- High school diploma or equivalent
Preferred Qualifications
- Experience with large-scale healthcare Payer/Provider SaaS platforms
- Associate's or Bachelor's degree in a related field
- Familiarity with common insurance plans and their prior authorization requirements
- Demonstrated ability to adapt to new technologies and software quickly
- Knowledge of HIPAA regulations and patient confidentiality
Perks & Benefits
- Competitive salary and comprehensive health benefits (medical, dental, vision)
- 401(k) retirement plan with company match
- Paid time off and company holidays
- Opportunities for professional development and career growth
- Hybrid work model offering flexibility and collaboration
- Employee assistance program
- Modern office environment with advanced technology
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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