Location : Remote, nationally sourced but needs to be available during the below shift time.
SHIFT : am- : pm EST, overtime not required but sometimes offered
Duration : months (possible extension, not Guaranteed)
Requirement : License / Certification : Current state’s Pharmacy Technician license and National Certification from Pharmacy Technician Certification Board (CPhT).
Job Description :
- Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required
- Obtain verbal authorizations and request detailed clinical information from prescribers
- Approve coverage determination requests based on defined criteria
- Enter and document coverage determination request decision into the PBM system and notify providers and / or members
- Respond to client inquiries regarding authorization approvals and PBM on-line applications
- Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
- Contact providers for additional information to facilitate coverage determination reviews
- Notify physicians, providers and members of coverage determination request decisions
Position Purpose : Track and triage all coverage determination requests for prior authorizations and Medicare Part D recipients
Education / Experience : High school diploma or equivalent. + years of retail, hospital or mail order pharmacy experience.
Walk me through the day to day responsibilities of this the role and a description of the project :
Technicians spend their days reviewing prior authorization requests submitted by providers and making coverage decisions based on the information received and the criteria for the plan they review for.
Describe the performance expectations / metrics for this individual and their team :
Once fully trained, our technicians are expected to process - cases per day for a total of - cases per week. They are also held to % quality standards as well.
Internal / External Groups with which the Candidate will interface : Required Skills / Experience : year pharmacy technician experience Preferred Skills / Experience : .
year Pharmacy Technician experience. . Customer Service / retail / Hospital experience preferred . Basic computer skills .
- Education Requirement : High school diploma or GED required Education Preferred :
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