Pharmacy Based Prior Authorization Specialist

Join our team at Wyandot Memorial Hospital, where you’ll find a supportive, community-focused environment, excellent benefits, and the opportunity to make a real difference in the lives of our patients. Be part of a dedicated team that values teamwork, professional growth, and a strong commitment to compassionate, high-quality care.

• High school diploma or equivalent; pharmacy technician education or experience preferred
• Registration with the Ohio Board of Pharmacy as a Registered Pharmacy Technician (or ability to obtain within 12 months)
• Strong knowledge of pharmaceuticals, medical terminology, and insurance processes
• Excellent written and verbal communication skills
• Detail-oriented with strong organizational and documentation skills
• Proficient with electronic medical records (EMR) systems and insurance portals
• Ability to collaborate with clinical staff, providers, and pharmacies to resolve issues
• Knowledge of 340B program, GPO contracts, and pharmacy inventory management preferred

• Review and analyze patient prescriptions and medical records to determine if prior authorization is required
• Submit prior authorization requests to insurance providers with all required documentation and clinical justification
• Communicate with healthcare providers, patients, and pharmacies to gather information and resolve denials
• Assist in the appeals process for denied authorizations, including documentation and letters of medical necessity
• Maintain accurate records of all prior authorization activities to ensure regulatory compliance and confidentiality
• Anticipate prescription refills to avoid therapy disruptions
• Collaborate with pharmacy staff across WMH locations to ensure timely patient care and adherence to protocols
• Provide oversight of drug ordering, receiving, storage, and inventory management for related medications
• Manage 340B program compliance, including split billing, procurement, and recordkeeping
• Support alternative distribution model drug ordering, tracking, and shipping to secondary sites
• Monitor financial parameters for pharmacy programs to remain within budget
• Stay current on insurance policy changes, coverage criteria, and pharmacy benefit updates
• Educate staff on prior authorization procedures, software use, and patient access processes