Pharmacy Authorization & Benefits Specialist

100 Horizon Healthcare Services, Inc; Newark (NJ); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Tuition Reimbursement

Wellness Programs

Paid Volunteer Time Off

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a Pharmacy Technician to handle prior authorization requests from physicians, pharmacies, and members. You will evaluate medical necessity against clinical criteria and coordinate with Pharmacy Services to support benefit design and claim issues.

Responsibilities include telephonic interactions with providers, processing ad hoc reports, ensuring service quality metrics, detecting potential fraud, waste and abuse, and supporting Medication

Qualifications

• Two years of pharmacy technician experience.
• Experience with third-party prescription program claim adjudication preferred.
• Requires National Pharmacy Technician Certification (PTCB or ExCPT).

Responsibilities

• Handle prior authorization requests via fax or help line and determine medical necessity.
• Interact telephonically with members, providers, and pharmacies to resolve eligibility and claim issues.
• Collaborate to optimize formulary compliance and generic dispensing.
• Maintain compliance with DMAHS and DOBI regulatory turnaround times.
• Identify potential fraud, waste, and abuse and refer accordingly.
• Support Medication Therapy Management and other clinical programs.

Skills

Pharmacy technician experience

Customer service

Verbal and written communication

Teamwork

Education

High School Diploma/GED

National Pharmacy Technician Certification (PTCB or ExCPT)

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a Pharmacy Technician to handle prior authorization requests from physicians, pharmacies, and members. You will evaluate medical necessity against clinical criteria and coordinate with Pharmacy Services to support benefit design and claim issues.

Responsibilities include telephonic interactions with providers, processing ad hoc reports, ensuring service quality metrics, detecting potential fraud, waste and abuse, and supporting Medication