Pharmacy Authorization Specialist (Pharmacy Technician)

UHS; Reno (NV); On-site; USD 55,000 - 74,000; Full time

Benefits offered by this job

Loan Forgiveness

Excellent Medical, Dental, Vision and

401(K) with company match

Job summary

Prominence Health Plan seeks a Pharmacy Authorization Specialist (Pharmacy Technician) to coordinate prior authorization reviews for injectable drugs between members, providers, and the health plan. You will load PA requests with diagnoses and billing codes, verify dose and frequency, and perform provider outreach to obtain documentation for coverage determinations.

This role supports an efficient pharmacy workflow and aims to improve satisfaction for members and providers with the prior

Qualifications

• High School diploma or equivalent.
• Current and valid state licensure as a pharmacy technician is required.
• 3+ years in hospital or retail pharmacy is preferred.
• Ability to communicate effectively in English, both verbally and in writing.
• Knowledge of medical terminology.

Responsibilities

• Coordinate prior authorization reviews for injectable drugs between Prominence Health Plan, members and providers.
• Load prior authorizations with diagnoses and billing codes, verify dose and frequency.
• Perform provider outreach to obtain documentation for coverage determinations.
• Improve internal workflow of the pharmacy team and enhance member/provider satisfaction.

Skills

Communication

Medical terminology

Customer service

Microsoft Office

English proficiency

Education

High School diploma or equivalent

Tools

Microsoft Office

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Pharmacy Authorization Specialist (Pharmacy Technician) serves as the coordinator between Prominence Health Plan, its members and contracted providers for the prior authorization review process. The main focus of this position is preparing and loading prior authorizations for injectable drugs. This includes ensuring proper diagnosis and billing codes are input and verifying the accuracy of the dose and frequency of submitted requests. In addition, this individual will perform provider outreach to obtain sufficient documentation for coverage determinations as necessary. We are looking for someone with an understanding of medical drug billing and a background that includes interpreting clinic notes and/or drug orders. By performing these duties, the Pharmacy Authorization Specialist will coordinate an effective and efficient review process, improving the internal workflow of the pharmacy team and increasing member and provider satisfaction with our prior authorization review process.

Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

Qualifications and Requirements:

• High School diploma or equivalent
• Current and valid state licensure as a pharmacy technician is required
• 3+ years in hospital or retail pharmacy is preferred
• Ability to effectively communicate in English, both verbally and in writing.
• Knowledge of medical terminology
• Exceptional customer service skills, interfacing between the health plan and providers' offices
• Understanding of the medical drug billing process
• Proficient in Microsoft Office
• Enjoys working in both individual and team settings
• Comfortable calculating doses and frequencies for medication treatment regimens
• Self-starter, resourceful and able to execute projects in a fluid and fast paced environment
• Strong analytical skills
• Knowledge of the purpose and process of prior authorizations
• Attention to detail and accuracy
• Ability to utilize technology and work within multiple software programs
• Understanding of health plan departments and functional areas for problem resolution
• Comfortable collecting and tracking performance metrics and reports

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.