Pharmacy Prior Authorization Technician

TALENT Software Services; Philadelphia (Philadelphia County); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Pharmacy Services Technician I to assist in the prior authorization process. This role involves reviewing and approving pre-authorization requests, ensuring compliance with established pharmacy guidelines, and maintaining a high level of productivity and quality. The ideal candidate will thrive in a fast-paced environment, possess strong communication skills, and demonstrate attention to detail. Join a dynamic team where your contributions will directly impact patient care and pharmacy operations, and enjoy the opportunity to grow in a supportive and collaborative workplace.

Qualifications

• Experience in pharmacy settings such as PBM, managed care, or retail pharmacy is preferred.
• Minimum typing speed of 35 words per minute is required.

Responsibilities

• Review and approve prior authorization requests based on pharmacy guidelines.
• Ensure compliance with HIPAA regulations and maintain data accuracy.

Skills

Interpersonal Skills

Written Communication

Oral Communication

Attention to Detail

Data Entry

Clinical Criteria Application

Education

Experience in PBM or Managed Care

1-3 years of relevant experience

Job description

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Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician I assists in the prior authorization process.

1. Responsible for reviewing and approving physician or member inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.
2. Responsible for accurate and timely data entry of prior authorization requests within the prior authorization system to meet all client-specific requirements and contractual agreements.
3. Responsible for understanding and applying clinical criteria for processing prior authorization requests in a timely manner.
4. Responsible for receiving prior authorization requests telephonically while utilizing multiple systems to confirm the accuracy of the information being provided.
5. Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered and recommends courses of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
6. Maintains a balance of productivity, quality, and timeliness of job accountabilities.
7. Participates in department self-audit procedures for ongoing evaluation of service.
8. Creates and supports an environment fostering teamwork, cooperation, respect, and diversity. Establishes and maintains positive communication and a professional demeanor with internal and external business partners at all times.
9. Ensures compliance with HIPAA regulations and AMFC policies and procedures.
10. Ability to adapt to a high-paced, changing environment.
11. Possesses strong interpersonal, written, and oral communication skills.
12. Demonstrates attention to detail and ability to follow instructions.
13. Attends required training on an annual basis.
14. Has strong knowledge of specialty and non-specialty pharmaceuticals.
15. Performs other related duties as assigned.

Experience in PBM, managed care, hospital pharmacy, LTC pharmacy, home infusion pharmacy, or retail pharmacy is preferred, with one to three years of relevant experience.

Minimum typing speed of 35 words per minute.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Other

Industries

• IT Services and IT Consulting