Certified Pharmacy Technician (CPhT)

Summary:

• This position takes in-coming calls from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process.
• Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.

Key Responsibilities:

• Handle incoming calls from members, providers, and other healthcare professionals.
• Deliver exceptional customer service while guiding callers through the Prior Authorization process.
• Review clinical documentation to determine completeness and eligibility based on established criteria.
• Accurately document all approvals and denials in a timely manner.
• Escalate clinical judgment calls and complex inquiries to the pharmacist for further evaluation.
• Maintain compliance with regulatory requirements and internal protocols