Job Title: Pharmacy Technician I Prior Authorization
Job Location: 100% Remote
Job Duration: 12 Months
Summary:
The Pharmacy Technician I Prior Authorization will provide professional and courteous support to members, providers, pharmacies, and other callers throughout the prior authorization process. The role involves handling high-volume inbound calls, processing and documenting prior authorization requests, and ensuring accurate and timely completion of reviews based on established criteria. Clinical questions, escalations, and judgment-based decisions will be transferred to the pharmacist team.
Responsibilities:
- Handle high-volume inbound calls from providers, pharmacies, members, and other healthcare stakeholders.
- Provide professional and courteous customer service while assisting callers with prior authorization inquiries.
- Process prior authorization requests using established criteria and procedures.
- Maintain complete, accurate, and timely documentation of prior authorization reviews, approvals, and denials.
- Escalate clinical questions, complex cases, and judgment calls to the pharmacist team.
- Process prior authorization requests received through fax and online portals.
- Make outbound calls as required to obtain or provide information.
- Monitor and respond to department mailboxes and other inquiries.
- Navigate multiple computer systems simultaneously while handling calls and documenting information.
- Utilize MS Teams, Outlook, Word, Excel, and other computer applications.
- Perform additional administrative and pharmacy-related duties as assigned by leadership.
- Maintain confidentiality and work within HIPAA requirements while working remotely.
Experience:
- Minimum 1 year of high-volume inbound call center experience; healthcare, insurance, PBM, pharmacy, or medical-office experience preferred.
- Pharmacy Technician experience preferred, particularly experience supporting administrative or prior authorization functions.
- Active Pharmacy Technician license, certification, or trainee license preferred but not required.
- Prior Authorization experience is strongly preferred.
- Strong customer service, verbal communication, and written communication skills.
- Advanced computer and data-entry skills with the ability to multitask across multiple systems.
- Proficiency with MS Teams and Outlook required; working knowledge of Word and Excel preferred.
- Must be comfortable working remotely with a private HIPAA-compliant workspace.
- Must have a hardwired internet connection with minimum speeds of 25 Mbps download / 3 Mbps upload.
- Must be available for approximately six weeks of training, Monday Friday, 8:00 AM 4:30 PM CST.
- After training, must be available for an assigned 8-hour Monday Friday shift between 8:00 AM CST and 12:00 AM CST, with potential weekend requirements.
Candidates must meet all requirements below:
- Hardwired internet connection required (Wi-Fi only is not acceptable)
- Internet speed test screenshot required with submission
- Minimum 25 Mbps download and 3 Mbps upload
- Private, HIPAA-compliant workspace required
- Ability to work on a computer for the duration of the shift
- Smartphone required for use of the PING application
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