Pharmacy Technician

Integrated Resources Inc.; Phoenix (AZ); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading company in healthcare seeks a dedicated Call Center Operator to handle high volume inbound calls related to prior authorization pharmacy requests. The role requires evaluating prescriptions, communicating decisions, and providing excellent customer service in a fast-paced environment. PTCB certification and experience in the pharmacy sector are essential, along with strong communication and technical skills.

Qualifications

• Minimum 6 months dispensing or retail experience required.
• In-depth knowledge of specialty injectable prescription drugs and J/Q codes.
• Proficiency in pharmacy computerized systems.

Responsibilities

• Communicates prior authorization decisions to medical staff.
• Documents prior authorization outcomes in pharmacy system.
• Resolves physician or client inquiries and grievances.

Skills

Excellent written and verbal communication

Ability to follow clinical criteria

Troubleshooting skills

Education

PTCB Certification

Experience in pharmacy industry

Knowledge of medical terminology

Tools

MS Office Suite

Pharmacy computerized systems

Job description

Description:
*THIS IS A CALL CENTER POSITION WHERE THE CANDIDATE MUST BE AWARE THAT THEY WILL BE HANDLING INBOUND CALLS IN A HIGH VOLUME CALL CENTER.*

Job Summary: Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

ESSENTIAL FUNCTIONS:

1. Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff, and/or pharmacists.
2. Researches, resolves, and documents prior authorization outcomes in pharmacy system.
3. Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician's office staff, medical management staff, and/or pharmacists.
4. Escalates requests to Pharmacist when extensive clinical review or denial is required.
5. Researches, resolves, and documents physician or client inquiries and grievances, providing verbal or written results to clients, prescribers, providers, and management.
6. Performs other duties as required.
7. Ability to identify and troubleshoot problematic issues.

Requirements/Certifications:

• PTCB Certification REQUIRED.
• Experience in specialty or retail pharmacy industry, reimbursement, or working in a health plan/healthcare setting.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management, medical terminology, and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in pharmacy computerized systems, software applications, and MS Office Suite.
• Excellent written and verbal communication skills.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training.
• Availability to work any shift from Monday to Sunday, 9:00 AM - 8:30 PM, with 2 days off.

Additional Information

All your information will be kept confidential according to EEO guidelines.