Clinical Pharmacy Technician II - (Patient Access) -Zelienople

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Zelienople, PA 16063 4050 Jacksons Pointe Ct Company: Allegheny Health Network

Job Description

JOB SUMMARY

This position is eligible for a $5,000 sign-on bonus for a 1-year commitment. This role requires a strong understanding of pharmacy benefits, insurance processes, and patient access procedures. Responsibilities include the coordination and administration of effective and efficient processing for pharmacy benefits prior authorization processes, insurance evaluations, addressing patient medication access issues, performing medication reconciliation, and overseeing referral screening and management.

ESSENTIAL RESPONSIBILITIES

Prior Authorization & Utilization Management

• Reviews pharmacy utilization management UM coverage requests for both pharmacy and medical benefits and prepares such cases for clinical review when required.
• Within the context of the request applies plan-specific benefits to each case appropriately summarizes pertinent facts and cites applicable internal policies and guidelines.

Patient & Provider Coordination

• Resolves non-clinical issues independently and acts as a liaison between customers, provider-facing teams, and the Pharmacy Department.
• Engages in member and provider outreach to resolve issues such as appeal initiation requests, processing errors, and fulfilling notification requirements.
• Schedules appointments, verifies patient information, and addresses inquiries.
• Performs referral screening and processing, coordinating with specialists and ensuring timely patient access to necessary services.

Data Management & Compliance

• Responsible for all preauthorization entries into applicable databases, i.e., internal medical claims systems, PBM pharmacy systems, to ensure swift and appropriate payment of services deemed medically necessary.
• Conducts insurance evaluations to determine patient eligibility and coverage for services.
• Performs medication reconciliation tasks to ensure accurate medication lists and prevent potential drug interactions.
• Maintains regulatory compliance and resolves all cases within predetermined timeframes.
• Assists patients with applications to access affordable medications.

Other duties as assigned or requested.

QUALIFICATIONS

Required:

• 2 years of experience as a Pharmacy Technician, Patient Access Coordinator, or Medical Assistant in a healthcare setting

Preferred:

• Associate degree
• Certified Pharmacy Technician (CPhT) from the Pharmacy Technician Certification Board

Language:

• Other than English (none)

Travel Requirement:

• 0 - 25

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures, as well as all data security guidelines established within the companys Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employees responsibility to comply with the companys Code of Business Conduct, which includes but is not limited to adherence to applicable federal and state laws, rules, and regulations, as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org.

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Apply Job Details

Job category: Pharmacy Position Type: Full Time Posted: 2026-01-21T16:08:03.8464380000 Locations: Zelienople, PA 16063 4050 Jacksons Pointe Ct Line of Business: Entity Recruiter: Hiring Manager Experience Level: Req ID J273675

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Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org.

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