Duration: 03 months with possible extensionShift Schedule: 8:30am-5:00pm EST, 9:00am-5:30pm EST, or 9:30am-6:00pm EST Job Description: 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.
Key Responsibilities:- 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.
Required 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.
Education:- High School/GED Required
- Certified Pharmacy Technician (PTCB or NHA). May be required to be licensed or certified in a specific state based upon contractual requirements and business need.
About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit
www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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