Overview

This role offers an opportunity for a licensed Pharmacy Technician to support the appeals process for Medicare and Medicaid members, with a primary focus on Medicare. The position centers on outbound phone-based customer service with members who may be frustrated about medication denials, requiring strong communication skills, empathy, and the ability to manage conversations effectively while maintaining accuracy in documentation and data entry.

Responsibilities

• Review denied prior authorization cases for Medicare and Medicaid members, with a primary focus on Medicare appeals.
• Make 30-60 outbound calls per shift to members and other relevant parties to obtain missing or clarifying information.
• Communicate clearly and empathetically with Medicare and elderly members who may be frustrated about medication denials.
• Gather and document clinical and administrative details related to medications, including injectable therapies administered in a doctor's office.
• Accurately enter and update case information in the appropriate systems and databases.
• Prepare complete and organized case files and forward them to pharmacists for final determination on whether to uphold or overturn denials.
• Follow established appeals procedures, guidelines, and timelines to ensure efficient and compliant case handling.
• Collaborate with pharmacists and other team members as needed to clarify case details and support timely decision-making.

Qualifications

• Active pharmacy technician license.
• Minimum 2 years of Experience working in a pharmacy or managed care environment.
• Knowledge of pharmacy operations, medication terminology, and prior authorization processes.
• Familiarity with appeals, managed care, claims, and denial workflows.
• Strong customer service skills over the phone.

Benefits

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
• Pay range $18.00 - $20.00/hr Apply To this Job