Specialty Pharmacy Technician Prior Authorization

Specialty Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative, technical, operational, and customer support assignments. Typically works on semi‑routine assignments and daily follow‐ups, collaborating with provider offices and insurance to troubleshoot and complete medication prior‑authorization requests for specialty medications.

• Manage daily worklists, conduct follow‑ups, and prioritize authorization requests.
• Research and interpret insurance claims using a broad array of clinical and informational resources to obtain relevant authorization information.
• Work directly with physician offices to initiate and complete prior‑authorization requests, ensuring compliance with quality standards and departmental protocols.
• Operate with opportunities for independent discretion and interpretation within established guidelines, supporting the delivery of high‑quality patient care and operational excellence.

• Must have an active license with the Board of Pharmacy in the state of residence (Ohio, Florida, Texas or Arizona).
• Must be certified by the Pharmacy Technician Certification Board (PTCB) or through ExCPT with an active certification.
• Must be able to research, read, and interpret clinical information.
• Critical thinker who can anticipate member/customer needs and take initiative, ask the right questions, and deliver the highest quality customer experience.
• Problem solver who can find viable solutions that meet member/customer needs, absent all ideal tools.
• Experience using multiple applications simultaneously and data‑entry skills.

• 2+ years of experience as a Pharmacy Technician or call center experience in a pharmacy or related setting.
• Mail Order Pharmacy or Specialty Pharmacy experience.
• Experience working with insurance plans and Medicare.
• 1+ years of experience submitting and reading pharmacy claims in RxNova.
• Experience with Scriptmed.

Hours
: 8‑hour shift between 8 a.m.–5:30 p.m. EST.

• Overtime:
  When there is a business need, overtime will be requested. Potentially voluntary or mandatory.
• Holidays:
  When there is a business need to work on a holiday outside of Thanksgiving and Christmas, there is the possibility of working on a holiday.

Work at Home Requirements
:
Self‑provided internet service must meet a minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL connection is suggested. In certain roles the minimum recommended speed may not be sufficient for business needs;
Humana reserves the right to require an upgrade. Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information. Occasional travel to Humana offices for training or meetings may be required.

Scheduled Weekly Hours
: 40

Pay Range
: $40,000 – $52,300 per year. Compensation may vary based on geographic location and individual pay will vary based on demonstrated job‑related skills, knowledge, education, certifications, etc.

Description of Benefits
:
Humana offers competitive benefits that support whole‑person well‑being, including medical, dental and vision benefits, 401(k) retirement savings plan, time off (paid time off, company and personal holidays, paid parental and caregiver leave), short‑term and long‑term disability, life insurance, and many other opportunities.

About Us
:
Center Well Pharmacy is a Humana company committed to providing safe, reliable pharmacy services and personalized clinical and educational services to improve health outcomes and medication adherence.

Humana is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.

Humana also has affirmative action policies in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and advance employees with disability or protected veteran status.