Pharmacy Prior Authorization Specialist

MetroPlusHealth; New York (NY); On-site; USD 45,000 - 60,000; Full time

Job summary

MetroPlusHealth is hiring a Prior Authorization Review Technician in New York, NY. You will input, review, and notify on prior authorization requests within the Pharmacy Adjudication system, and handle member inquiries while supporting pharmacy operations.

The role requires an Associate degree (or equivalent) with 3 years of Pharmacy Technician experience, and a PTCB or ExCPT certification. Proficiency in Word, Excel, PowerPoint is required, with preferred Access skills.

Qualifications

• Associate's degree and 3 years of Pharmacy Technician experience required; bachelor's degree preferred.
• Or, a high school diploma/GED and 5 years of experience as a Pharmacy Technician required.
• Pharmacy experience in a managed care environment preferred.
• Auditing experience preferred.
• Experience with government programs, including Medicare, Medicare Part D, and Medicaid, preferred.
• Proficiency in Microsoft Word, Excel, and PowerPoint required.
• Proficiency in Microsoft Access preferred.

Responsibilities

• Inputs all received medical and pharmacy benefit prior authorization requests into processing platforms, ensuring the accurate transcription of all information.
• Reviews select prior authorization requests and provide recommendations in accordance with internal guidelines and review criteria.
• Answers inquiries from members, providers, pharmacies, and other stakeholders received through the pharmacy call center.
• Provides verbal notification of prior authorization decisions and enters accurate medication overrides into the pharmacy adjudication platform.
• Performs audits of vendor-entered medication overrides in the pharmacy adjudication platform.
• Assists with pharmacy case management activities.
• Supports departmental quality improvement initiatives.
• Answers all triaged inquiries related to MetroPlusHealth pharmacy and medical benefits.

Skills

Pharmacy technician

Microsoft Word

Microsoft Excel

PowerPoint

Microsoft Access

Auditing

Managed care

Customer service

Education

Associate's degree

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Microsoft Access

Job description

MetroPlusHealth is hiring a Prior Authorization Review Technician in New York, NY. You will input, review, and notify on prior authorization requests within the Pharmacy Adjudication system, and handle member inquiries while supporting pharmacy operations.

The role requires an Associate degree (or equivalent) with 3 years of Pharmacy Technician experience, and a PTCB or ExCPT certification. Proficiency in Word, Excel, PowerPoint is required, with preferred Access skills.