Pharmacy Prior Authorization Specialist

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Pharmacy Technician to handle prior authorization requests from pharmacists, physicians and members, evaluate medical necessity, and support Pharmacy Services benefits.

You will interact with providers, process claims issues, ensure regulatory turnaround times, and contribute to Medication Therapy Management programs within a team-focused, compliant environment.

Qualifications

• Strong verbal and written communication skills.
• Ability to work well within a team and deliver accurate information.
• Proven time management and ability to manage multiple priorities.

Responsibilities

• Handle telephonic interactions with members, physician offices, pharmacies and internal stakeholders for eligibility and coverage determinations.
• Engage with physicians and pharmacists to facilitate formulary compliance and optimize dispensing.
• Capture accurate clinical information for Prior Authorization requests for medical review.
• Meet regulatory turnaround times and satisfy DMAHS and DOBI requirements.
• Process complaints, appeals, grievances, and compliance inquiries.
• Identify potential fraud, waste, and abuse and initiate internal referrals.

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Pharmacy Technician to handle prior authorization requests from pharmacists, physicians and members, evaluate medical necessity, and support Pharmacy Services benefits.

You will interact with providers, process claims issues, ensure regulatory turnaround times, and contribute to Medication Therapy Management programs within a team-focused, compliant environment.