Certified Pharmacy Technician
Remote
Description:
Diversified Systems is searching for a Certified Pharmacy Technician to support prior authorization operations in a remote environment. The successful candidate will be responsible for processing prior authorization requests, supporting providers and authorized representatives, ensuring compliance with regulatory requirements, and maintaining productivity and quality standards.
Responsibilities:
- Receive and process prior authorization requests submitted through electronic, fax, and verbal channels in accordance with client, regulatory, and operational guidelines.
- Answer inbound calls from providers and authorized representatives for verbal prior authorization requests.
- Utilize multiple systems, clinical resources, and reference tools to investigate requests and support accurate processing and decision-making.
- Maintain productivity, quality, and accuracy standards established by the department while meeting daily production goals.
- Identify trends, process improvement opportunities, and workflow enhancements and provide recommendations to leadership to improve operational efficiency and service delivery.
- Ensure compliance with HIPAA, CMS requirements, client policies, accreditation standards, and all applicable regulatory requirements.
- Participate in training, calibration sessions, quality reviews, and ongoing education to maintain knowledge of prior authorization processes, clinical criteria, and system updates.
- Adhere to the telework policy.
- Maintain a reliable high-speed internet connection and telework environment that supports uninterrupted job performance.
- Minimize system downtime, promptly report technology issues, and remain actively engaged and available during scheduled work hours in accordance with the telework and workforce management policies.
- Maintain idle time at or below department-established thresholds.
- Perform other duties as assigned.
Key Performance Indicators (KPIs):
- Meet or exceed established daily and monthly production goals.
- Maintain quality audit scores of 90% or higher.
- Maintain documentation accuracy and completeness standards.
- Meet departmental turnaround time (TAT) requirements.
- Process prior authorization requests accurately and timely.
Requirements:
- Certified Pharmacy Technician credential required.
- Experience processing prior authorization requests required.
- Experience working with healthcare, pharmacy, or managed care systems required.
- Ability to interpret and apply clinical, regulatory, and operational guidelines required.
- Strong attention to detail and documentation accuracy required.
- Excellent communication and customer service skills required.
- Ability to manage multiple systems and resources simultaneously required.
- Knowledge of HIPAA, CMS requirements, and healthcare compliance standards required.
- Ability to work independently in a remote environment required.
- Reliable high-speed internet connection required.
About Diversified Systems
Founded in 1990, Diversified Systems is an award-winning Technology Services corporation providing all levels of IT project consulting services nationwide. DSI is headquartered in Columbus, Ohio with regional offices in the American Midwest and East Coast. We offer our consultants a number of flexible and competitive compensation benefit packages.
Diversified Systems is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations.
Diversity, Equity and Inclusion
DSI values authenticity and is committed to making sure our employees and partners are valued and respected. At DSI, we believe building a diverse culture is important because we know when people work together, we can achieve better results as a team. DSI realizes that everyone comes from various backgrounds. We celebrate these differences because our employees are our greatest asset as we strive to best meet the needs of those we serve. As part of our ongoing efforts, DSI is focused on advancing equality, diversity, and inclusion by setting high standards to continually evolve our culture. This includes but is not limited to recruiting, community involvement, client delivery, and career development.