Pharmacy Prior Authorization Specialist

CareSource; Indianapolis (IN); On-site; USD 36,000 - 57,000; Full time

Job summary

CareSource is seeking a Pharmacy Technician II to support data entry and review of prior authorization requests. The role involves assisting providers and pharmacies, managing escalations, and ensuring timely resolution of inquiries in the pharmacy department.

Key responsibilities include reviewing requests, sending communications, educating providers on formulary alternatives, and documenting interactions.

Qualifications

• High school diploma or equivalent required.
• 3+ years retail or hospital pharmacy experience preferred.
• Managed care prior authorization experience preferred.

Responsibilities

• Review traditional and specialty prior authorization requests.
• Send and follow up on faxes to providers.
• Educate providers about formulary alternatives.
• Place prior authorizations when appropriate.
• Route requests for pharmacist review.
• Answer provider calls regarding coverage and formulary issues.
• Document telephonic interactions in systems.
• Ensure inquiries are answered within mandated time frames.
• Assist Case Managers and Provider Services with pharmacy issues.
• Maintain knowledge of policies for all markets.

Skills

Computer proficiency

Phone/telephony

Attention to detail

Time management

Independent / team player

Education

High School Diploma or equivalent

Pharmacy Technician Certification

Tools

Microsoft Word

Outlook

Excel

Job description

CareSource is seeking a Pharmacy Technician II to support data entry and review of prior authorization requests. The role involves assisting providers and pharmacies, managing escalations, and ensuring timely resolution of inquiries in the pharmacy department.

Key responsibilities include reviewing requests, sending communications, educating providers on formulary alternatives, and documenting interactions.