Analysis Skills, Claims Processing, Clinical Medicine, Code Reviews, Communication Skills, Compensation and Benefits, Current Procedural Terminology (CPT), Customer Support/Service, Data Analysis, Database Administration, Documentation Review, HIPAA (Health Insurance Portability and Accountability Act), Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Hospital, ICD-10, Maintain Compliance, Managed Care, Medications, Microsoft Excel, Operational Support, Outpatient Care, Pharmacy, Problem Solving Skills, Quality Assurance, Quality Management, Regulatory Compliance, Reimbursement, Reporting Skills, Support Documentation
Pharmacy Technician – Outpatient / Managed Care
Location: Portland, OR
Duration: 26 Weeks
Schedule: Day Shift | Standard Business Hours
On-Call: 2–3 weekends per year
Job Summary
"Navitas Healthcare, LLC" is seeking an experienced Pharmacy Technician to support pharmacy operations, pharmacy benefit administration, prior authorizations, claims processing, and member services within a managed care environment. This role requires strong pharmacy benefit knowledge, prior authorization experience, advanced Excel skills, and the ability to work independently in a fast-paced healthcare setting.
Key Responsibilities
- Process and coordinate pharmacy prior authorizations
- Review medication utilization criteria and pharmacy benefit requirements
- Support pharmacy claims processing and reimbursement activities
- Research and resolve pended claims and authorization issues
- Communicate with providers, pharmacies, members, and healthcare teams
- Maintain pharmacy databases and eligibility records
- Analyze pharmacy data and generate reports using Advanced Excel
- Support coding and documentation review using ICD-10, CPT, HCPCS
- Audit pharmacy claims and records for quality and compliance
- Train providers and staff on pharmacy workflows and systems
- Assist with quality improvement initiatives and workflow optimization
- Maintain HIPAA and regulatory compliance standards
Requirements
- Active Oregon Pharmacy Technician License Required
- Advanced Microsoft Excel Skills Required
- Minimum 2 Years of Pharmacy Technician Experience in Managed Care Environment OR Bachelor's Degree
- Prior Authorization Experience Required
- Pharmacy Benefit Management (PBM) or Health Plan Experience Required
- Claims Processing Experience Preferred
- Knowledge of ICD-10, CPT, HCPCS Coding
- Strong Analytical and Problem-Solving Skills
- Excellent Customer Service and Communication Skills
For more details reach at
sthakur@navitashealth.com
About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.