This position takes in-coming calls from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process.
Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.
Job Responsibilities
Key Responsibilities:
Handle incoming calls from members, providers, and other healthcare professionals.
Deliver exceptional customer service while guiding callers through the Prior Authorization process.
Review clinical documentation to determine completeness and eligibility based on established criteria.
Accurately document all approvals and denials in a timely manner.
Escalate clinical judgment calls and complex inquiries to the pharmacist for further evaluation.
Maintain compliance with regulatory requirements and internal protocols
Numbers & Facts
Location
(Remote)
Job Type
Contractor
Salary
$20–$21 Per Hour
Year Founded
null
Qualifications
Required:
At least 1 year experience as a pharmacy technician coordinating activities in an administrative support function. (preferred)
The Pharmacy Technician certification is preferred but not required at a state or national level.
Top 3 Skills Required:
High-Volume Healthcare Call Center Experience
Minimum 1 year of inbound call center experience
Healthcare, insurance, PBM, pharmacy, medical office, or similar environment preferred
Strong customer service and communication skills
Pharmacy Technician Experience / Knowledge
Pharmacy Technician experience strongly preferred
Active Pharmacy Technician License, Certification, or Trainee License preferred
Computer Multitasking & Documentation Skills
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