Prior Authorization Technician I - Contract

Reporting directly to the Supervisor, Prior Authorization Technicians, the Prior Authorization Technician I processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications. Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.

Prior Authorization Technician I 

Duration: 3+ Months

Location: Remote
Experience: 1–3 Years
Shift: EST hours

• 8:30 AM – 5:00 PM
• 9:00 AM – 5:30 PM
• 9:30 AM – 6:00 PM

Weekend/Holiday: Must be available as needed.

Position is remote. No time zone preference but shift times offered will be in EST time so candidates will need to adjust accordingly if in a different time zone. Shift Schedule: 8:30am-5:00pm EST, 9:00am-5:30pm EST, or 9:30am-6:00pm EST

Required

• PRIOR AUTHORIZATION PROCESSING
• CLINICAL CRITERIA INTERPRETATION
• MEMBER CLAIMS HISTORY UTILIZATION
• OUTBOUND CALLING
• AUTHORIZATION SUBMISSION

Duties:
Reporting directly to the Supervisor, Prior Authorization Technicians, the Prior Authorization Technician I processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications.
 

Essential Functions
Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable
Utilizes member claims history during the prior authorization review process
Makes outbound calls to obtain additional information needed to process prior authorization requests
Submits authorizations to pharmacy and medical claims processors
Forwards prior authorization requests to a pharmacist when necessary
Makes appropriate referrals to other clinical programs
Assists in directing appropriate requests to in network providers
Receives inbound calls from the customer care center with prior authorization related inquiries
Assist with Appeals processing as assigned
Ability to multitask between various tasks and systems while maintaining required productivity and quality levels
Ability to make changes in a fast-paced environment
Strong knowledge of specialty and non-specialty pharmaceuticals
Performs other job-related duties and projects as assigned
Attends required training on an annual basis.
Adheres to corporate and departmental policies and procedures.
Available to work weekends and holidays.

Skills:

1 to 3 Years required.
Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
Minimum 35 words per minute typing speed.

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