Pharmacy Prior Authorization Specialist

HireTalent; United States; On-site; USD 42,000 - 62,000; Full time

Job summary

HireTalent is seeking a Pharmacy Technician dedicated to high quality pharmacy decision-making and improving member and provider experiences. This role focuses on processing prior authorizations requests and supporting escalated PA issues.

You will use Oscar and vendor tools to determine eligibility, gather information, meet timelines, and communicate outcomes, while ensuring compliance with laws and regulations.

Qualifications

• 1+ years of work experience in a pharmacy-related field.
• Preferred: pharmacy reviews for managed care plan or PBM.
• Strong verbal and written communications and interpersonal interactions.
• Excellent customer service, phone etiquette, and typing skills.

Responsibilities

• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests
• Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information
• Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making
• Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
• Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for timeliness, content and accuracy
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

Verbal communication

Written communication

Interpersonal skills

Customer service

Phone etiquette

Typing skills

Job description

HireTalent is seeking a Pharmacy Technician dedicated to high quality pharmacy decision-making and improving member and provider experiences. This role focuses on processing prior authorizations requests and supporting escalated PA issues.

You will use Oscar and vendor tools to determine eligibility, gather information, meet timelines, and communicate outcomes, while ensuring compliance with laws and regulations.