The essential functions of a pharmacy technician in Prior Authorization are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non-formulary medications, while ensuring a high level of customer service and maximizing productivity. Request can be received via fax or telephone, from providers’ offices and pharmacists.
- The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements. Responsibilities:
- Using established criteria and guidelines, the pharmacy technician receives and processes prior authorization requests made by providers and members for medications not inherently covered on a member’s prescription drug plan.
- Answers prior authorization inquiry calls or/and faxes as well as research and resolve formulary and benefit issues using the appropriate reference material.
- Performs other duties as assigned by management.
- Handles inbound phone requests and gathers member data to provide information for Pharmacist consultations.
- Training is for 4 weeks. Training time is 8:00am-5:00pm. Monday- Friday. This training time is subject to change
- Dependent on business needs, candidate could work up to 4 hours a day OT.
- Candidate must have their own home internet access/VPN (internet can be hard wired with Ethernet cord).
- Candidate must have level skill with working with PC (ex. Using mouse and keyboard, accessing and navigating through multiple systems and screens) *Excellent Attendance is a must Onshore/Offshore Onshore Resource Type Non IT Contractor.
- Minimum Education Requirement: Pharmacy Technician License or Pharmacy Technician Certification Board (PTCB)
MUST BE FULLY BILINGUAL AND COMPUTER PROFICIENT