Specialty Pharmacy Technician Prior Authorization

CenterWell

Columbus, OH(remote)

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JOB DETAILS

SALARY

$40,000–$52,300 Per Year

SKILLS

Affirmative Action, Call Centers, Certified Pharmacy Technician (CPhT), Chronic Disease, Clinical Information, Customer Experience, Customer Support/Service, Data Entry, Establish Priorities, Health Education, Healthcare, Healthcare Providers, Healthcare Quality, Home Care, Hospice Care, Identify Issues, Insurance, Insurance Claims, Internet/Online Service, Maintain Compliance, Medical Office, Medicare, Medications, Operational Support, Patient Care, Pharmacy, Primary Care, Problem Solving Skills, Quality Metrics, Rehabilitation Act, Requirements Validation/Verification, Research Skills, Retail, Training/Teaching, Willing to Travel, Work From Home

LOCATION

Columbus, OH

POSTED

Today

Become a part of our caring community

The Specialty Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/technical/operational/customer support assignments. Typically work on semi-routine assignments and daily follow ups. Work with providers offices and insurance to troubleshoot and complete medication prior authorization requests for specialty medications.

The Specialty Operations Pharmacy Technician 2 (Prior Authorizations) will oversee the following:

+ Manage daily worklists, conducting follow-ups, and prioritizing authorization requests.

+ Research and interpret insurance claims, while using a broad array of clinical and informational resources to obtain relevant authorization information.

+ Work directly with physician offices to initiate and complete prior authorization requests, ensuring compliance with quality standards and departmental protocols.

+ Operate with opportunities for independent discretion and interpretation within established guidelines, supporting the delivery of high-quality patient care and operational excellence.

Use your skills to make an impact

Required Qualifications

+ Must have an active license with the Board of Pharmacy in the state of residence (Ohio, Florida, Texas or Arizona).

+ Must be certified by the Pharmacy Technician Certification Board (PTCB) or through ExCPT with an active certification.

+ Must be able to research, read & interpret clinical information.

+ Critical thinker who can anticipate member/customer needs and take initiative, ask the right questions and deliver the highest quality customer experience.

+ Problem solver who can find viable solutions that meets member/customer needs, absent from all ideal tools.

+ Experience using multiple applications simultaneously and data entry skills.

Preferred Qualifications

+ 2+ years of experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting.

+ Mail Order Pharmacy or Specialty Pharmacy experience.

+ Experience working with insurance plans and Medicare.

+ 1+ years of experience submitting and reading pharmacy claims, in RxNova.

+ Experience with Scriptmed.

Additional Information

Hours : The preferred hours of operation for this position will be an 8-hour shift sometime between the hours 8 a.m.-5:30 p.m. EST

+ Overtime : When there is a business need, overtime will be requested. Potentially voluntary or mandatory.

+ Holidays : When there is a business need to work on a holiday outside of Thanksgiving day and Christmas Day, there is the possibility of working on a holiday.

Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

About the Company

CenterWell

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