Prior Authorization Technician

Duties • The Prior Authorization Technician I assists in the prior authorization process. • Reports directly to the Supervisor, Prior Authorization Technicians. • Processes prior authorization requests received from providers, members, and pharmacies, including requests for high-cost and specialty medications. • 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 • Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, and retail pharmacy experience preferred. • Minimum 35 words per minute typing speed. Education • High School/GED • Certified Pharmacy Technician (PTCB or NHA) Required Apply tot his job Apply To this Job