Job Description:

• Our Clinical Pharmacy Technician processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.
• Performs analysis, obtains information, and enters prior authorization data necessary for claims adjudication.
• Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on 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.
• Enter prior authorizations into the system and prioritize requests.
• Check formulary alternatives and review tried and failed medications.
• 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.
• Conform to defined roles & 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.
• Analyze, research, and resolve prior authorization processing issues, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from supervisor or clinical pharmacists; and referring unique or high dollar requests to supervisor according to guidelines.
• Coordinate within client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests.
• Document prior authorization-related information and status.
• Make outbound calls to obtain information and answer questions about prior authorization status.
• Protect and maintain 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.
• Identify and recommend operational improvements.
• Participate in and support all applicable Quality Management initiatives.
• Maintain a flexible schedule to meet client needs, as needed.
• Adhere to all policies and procedures.
• Take feedback and responsibility for performance.
• Adapt to the differences of clients.
• Support all Compliance Program activities.
• Complete other duties and responsibilities as directed

Requirements:

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Moderate-to-high level of medication and disease state knowledge within the scope of pharmacy practice
• Personal computer literacy and high competency in using Microsoft Word, Excel, Adobe, etc.
• Strong organizational skills with attention to detail
• Strong oral and written communication skills
• Excellent critical thinking capabilities with a strong attention to detail
• Exceptional customer service skills
• Minimum one-year prior authorization experience preferred
• Health plan or Pharmacy Benefit Manager experience preferred

Benefits:

• healthcare, vision and dental insurance
• a generous 401k match
• paid vacation
• personal time
• holidays
• growth and training opportunities
• a team atmosphere with fun events and prizes scheduled throughout the year