Position Responsibilities:
- Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines
- Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review
- Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
- Review and analyze pharmacy claims data for proactive outreach and intervention.
- Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team
- Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
- Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
- Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
- Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment
Required Qualifications:
- 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
- Experience handling prior authorization requests/understanding of prior authorization requirements required
- National Certified Pharmacy Technician (CPhT) license, required
- High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred
- Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
- Ability to multi-task and collaborate in a team with shifting priorities