Prior Authorization Pharmacy Technician (PST or MST only!)

POSITION DETAILS : Position :

Prior Authorization Coordinator / Pharmacy Technician

Location : Remote

Schedule :

5 days per week, could be scheduled weekend days

Shifts :

either 8 : 30-5 or 9-5 : 30 PT

Pay :

up to $23.50hr W2 (with benefits)

Must-haves :

1+ year of experience as a Pharmacy Technician

Active Pharmacy Technician certification (national certification or state licensure)

Strong experience with prior authorizations

Experience with inbound / outbound calls

Strong data entry skills and attention to detail

Intermediate knowledge of MS Office / Word, Excel, and Outlook and aptitude for new programs

Experience with Windows based database programs

Plusses (but NOT required) :

Experience with Cisco Finesse phone system

Position Summary

Works as a member of the Prior Authorization Operations team.

Processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.

Uses various business applications (MedResponse, MedAccess, FileNet, RightFax, etc.) to perform analysis, obtain information, and enter prior authorization data necessary for claims adjudication.

Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based upon clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).

Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.

Essential Functions and Responsibilities :

Process and finalize PA requests within clients’ turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines.

Enter prior authorizations (Pas) into the system and prioritize requests.

Check formulary alternatives, review tried and failed medications, apply Prior Authorization Guidelines.

Utilize drug references and verify the drug being requested is indicated and approved for the condition.

Document all related information regarding the PA approval or non-approval.

Respond to incoming requests via phone, fax, ePA and returning status of the PA to the physicians and pharmacies.

Conforms to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision making.

Partners with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.

Accountable to achieve prior authorization processing productivity and accuracy standards.

Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career path level, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from team subject matter experts (SME) or supervisor; and referring unique or high dollar requests to supervisor according to guidelines.

Coordinates notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations.

Documents prior authorization related information and status. Makes outbound calls to obtain information and answer questions about prior authorization status.

Collaborates with client teams to understand PBM clients’ prior authorization processing requirements and expectations. As appropriate for experience and career path level, partners with client teams to complete special prior authorization processing projects and provide accurate, timely, and reliable information to client claim inquiries.

Collaborates with Contact Center Services in resolving prior authorization inquiries and handling incoming calls during periods of high volume.

Protects and maintains confidentiality and privacy of all prior authorization and member information, including following strict protocols for date stamping and storage / security of prior authorization forms and related information.

Compensation : Up to $23.50hr

Exact compensation may vary based on several factors, including skills, experience, and education. Employees in this role will enjoy a comprehensive benefits package starting on day one of employment, including options for medical, dental, and vision insurance. Eligibility to enroll in the 401(k) retirement plan begins after 90 days of employment. Additionally, employees in this role will have access to paid sick leave and other paid time off benefits as required under the applicable law of the worksite location.