Pharmacy Prior Authorization Technician

TALENT Software Services; Philadelphia (Philadelphia County); On-site; USD 40,000 - 65,000; Full time

Job summary

An established industry player in IT Services is seeking a dedicated Pharmacy Services Technician I to support the prior authorization process. This role involves reviewing medical necessity requests and ensuring compliance with pharmacy guidelines. The ideal candidate will have strong interpersonal and communication skills, a keen attention to detail, and a commitment to maintaining high standards of service. Join a collaborative team that values respect and diversity while contributing to essential healthcare services. If you are passionate about making a difference in the pharmacy field, this opportunity is perfect for you.

Qualifications

• 1-3 years of pharmacy experience preferred.
• Strong knowledge in specialty and non-specialty pharmaceuticals.

Responsibilities

• Assist in the prior authorization process for pharmacy requests.
• Review and approve physician inquiries for pre-authorization.

Skills

Interpersonal Skills

Attention to Detail

Communication Skills

Typing Speed (35 wpm)

Education

PTCB or NCCT Certification

Job description

2 days ago Be among the first 25 applicants

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

• Responsible for reviewing and approving physician or member inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.
• 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.
• Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner.
• Responsible for receiving prior authorization requests telephonically while utilizing multiple systems to confirm accuracy of the information being provided.
• Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered. Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
• Maintains a balance of productivity, quality and timeliness of job accountabilities.
• Participates in department self-audit procedures for ongoing evaluation of service.
• Creates and supports an environment which fosters teamwork, cooperation, respect, and diversity. Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.
• Compliance with HIPAA regulations and AMFC policies and procedures.
• Ability to adapt to a high pace changing environment.
• Strong interpersonal, written, and oral communication skills.
• Attention to detail and ability to follow instructions.
• Attends required training on an annual basis.
• Strong knowledge in specialty and non-specialty pharmaceuticals.
• Performs other related duties as assigned.
  
  

Qualifications:

• One to three years of previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, or retail pharmacy experience preferred.
• Minimum 35 words per minute typing speed.
• Current PTCB or NCCT Certificate Preferred.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  IT Services and IT Consulting

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