Pharmacy Technician-REMOTE IN MST/PST ONLY
About the position Responsibilities • Process and finalize prior authorization requests within clients' turnaround time and performance guarantees using established guidelines. • Enter prior authorizations into the system, prioritize requests, and check formulary alternatives. • Review tried and failed medications and 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 prior authorization approval or non-approval. • Respond to incoming requests via phone, fax, ePA, and return status of the prior authorization to physicians and pharmacies. • Conform to defined roles and responsibilities and rules of engagement between prior authorization processing and clinical decision making. • Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing. • Achieve prior authorization processing productivity and accuracy standards. • Analyze, research, and resolve prior authorization processing issues as appropriate for experience and career path level. • Coordinate notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations. • Document prior authorization-related information and status. • Make outbound calls to obtain information and answer questions about prior authorization status. • Collaborate with MCO and Self-Insured client teams to understand PBM clients' prior authorization processing requirements and expectations. • Collaborate with Contact Center Services in resolving prior authorization inquiries and handling incoming calls during periods of high volume. • Protect and maintain confidentiality and privacy of all prior authorization and member information. Requirements • Certified Pharmacy Technician (CPhT) • At least 1 year of prior remote prior authorizations experience • Active license in state of residence • Minimum of 3 years of pharmacy technician experience • Understanding of managed pharmacy benefit concepts including formulas, prior authorizations, edits, and claim adjudication • Working knowledge of customer service in a retail/outpatient pharmacy environment • Familiarity with pharmacy software data submission requirements such as CovermyMeds or Electronic Prior Authorization (e-PA) • Intermediate knowledge of MS Office/Word, Excel, and Outlook • Experience with Windows-based database programs Nice-to-haves • Ideal tenure of at least 2 years/role (exceptions can be made for relocating, store closure, etc.) • Aptitude for new programs Benefits • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Apply tot his job Apply tot his job