Pharmacy Prior Authorization Technician

Title:

Pharmacy Technician - Prior Authorization

Schedule:

Monday-Friday 8:30a-5p

Description:
Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician will assist in the prior authorization process.

What You Will Do:
Responsible for reviewing and approving physician or member inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.
Responsible for accurate and timely data entry of prior authorization requests within the Prior authorization system to meet all client specific requirements and contractual agreements.
Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner.
Responsible for receiving prior authorization requests telephonically while utilizing multiple systems to confirm accuracy of the information being provided.
Supports Fraud and Abuse program system oversight by reviewing medication utilization records.
Communicates any suspected fraud discovered.
Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
Maintains a balance of productivity, quality, and timeliness of job accountabilities.
Participates in department self-audit procedures for on-going evaluation of service.
Creates and supports an environment which fosters teamwork, cooperation, respect, and diversity.
Always establish and maintain positive communication and professional demeanor with internal and external business partners.
Compliance with HIPAA regulations and AMFC policies and procedures.
Performs other related duties as assigned.
You Will Be Successful If:

Ability to adapt to a high pace changing environment.
Strong interpersonal, written, and oral communication skills.
Attention to detail and ability to follow instructions.
Attends required training on an annual basis.
Strong knowledge of specialty and non-specialty pharmaceuticals.

What You Will Bring:

At least 1+ years of experience working as a pharmacy technician specifically prior authorization.
Previous PBM, managed care, hospital pharmacy, LTC pharmacy, home Infusion pharmacy, retail pharmacy experience preferred.
Minimum 35 words per minute typing speed.
Current PTCB or NCCT Certificate Preferred
High School Diploma or GED required.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!