Pharmacy Prior Authorization Specialist II

CareSource; Indianapolis (IN); Vor Ort; USD 36.000 - 57.000; Vollzeit

Zusammenfassung

CareSource is seeking a Pharmacy Technician II to handle data entry and review of prior authorization requests, assist providers and pharmacies, and ensure timely resolution of escalations within the pharmacy department.

You will review traditional and specialty medication PA requests, educate providers on formulary alternatives, and place authorizations when appropriate in the PA systems. Strong communication with providers and teams is essential.

Qualifikationen

• High School Diploma required.
• Three (3) years retail pharmacy or hospital pharmacy experience preferred.
• One (1) year managed care prior authorization experience preferred.

Aufgaben

• Review traditional and specialty medication prior authorization requests for the member’s pharmacy benefit submitted by providers.
• Send fax communications to providers when necessary.
• Contact provider offices to follow up on failed faxes.
• Educate CareSource providers about resources outlining formulary alternatives.
• Place prior authorizations for when approval is appropriate in the prior authorization system(s).
• Initiate process for routing prior authorizations requiring review by a pharmacist.
• Answer calls from providers regarding prior authorization requests prescription coverage and formulary issues in a timely manner.
• Perform outbound calls to obtain information from providers and/or pharmacies.
• Document all telephonic interaction in appropriate system(s).
• Ensure all methods of inquiries (fax, e-mail, ePA) and submissions are answered within the state mandated period.

Kenntnisse

Typing 40 WPM

Windows proficiency

MS Office basics

Professional telephone communication

Medical terminology

Healthcare knowledge

Provider communication

Ausbildung

High School Diploma

Tools

Prior authorization systems

Jobbeschreibung

CareSource is seeking a Pharmacy Technician II to handle data entry and review of prior authorization requests, assist providers and pharmacies, and ensure timely resolution of escalations within the pharmacy department.

You will review traditional and specialty medication PA requests, educate providers on formulary alternatives, and place authorizations when appropriate in the PA systems. Strong communication with providers and teams is essential.