Pharmacy Prior Authorization Specialist II

CareSource; Indianapolis (IN); On-site; USD 49,000 - 79,000; Full time

Job summary

CareSource in Indianapolis, IN is seeking a Pharmacy Technician II to enter and review prior authorization requests, assist providers and pharmacies, and resolve escalations in the pharmacy department.

The role requires strong data entry, phone communication, and knowledge of Medicaid/Marketplace, with 3 years retail/hospital pharmacy experience and 1 year managed care prior authorization preferred; a high school diploma is mandatory.

Qualifications

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

Responsibilities

• 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.

Skills

Data entry

Phone calls

Attention to detail

Time management

Teamwork

Medical terminology

Typing 40 WPM

Customer service

Education

High School Diploma

Retail/hospitalpharmacy experience

Managed care prior authorization experience

Tools

Windows

MS Word

MS Outlook

MS Excel

Job description

CareSource in Indianapolis, IN is seeking a Pharmacy Technician II to enter and review prior authorization requests, assist providers and pharmacies, and resolve escalations in the pharmacy department.

The role requires strong data entry, phone communication, and knowledge of Medicaid/Marketplace, with 3 years retail/hospital pharmacy experience and 1 year managed care prior authorization preferred; a high school diploma is mandatory.