Certified Pharmacy Technician (CPhT)

SUMMARY:

• Handle high-volume inbound calls from members, providers, and pharmacies.
• Assist with criteria-based Prior Authorization requests.
• Review and process PA requests received by phone, fax, and ePA.
• Maintain accurate and timely documentation of reviews, approvals, and denials.
• Make outbound calls and respond to department mailbox inquiries.
• Coordinate with internal teams regarding PA status and results.
• Escalate clinical questions and judgment calls to the pharmacist team.
• Provide professional and courteous customer service.
• Perform additional administrative duties as assigned

Respnsibilities:

• 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