Pharmacy Technician II: Prior Authorization Expert

CareSource; Butlerville (IN); On-site; USD 23,000 - 39,000; Full time

Job summary

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

The role emphasizes accurate data handling, timely communication with providers, and collaboration with case managers to support Medicaid/Marketplace programs. Some shifts may include evenings or weekends as needed.

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 with in the state mandated period
• Involvement in special projects reviewed by the management team when needed
• Answer calls and troubleshoot issues from retail and specialty pharmacies
• Assist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questions
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Maintain knowledge and understanding of all processes and procedures for all markets on faxes and phones
• Adhere to all departmental and company policies and procedures
• Perform any other job duties as requested

Skills

Windows OS

Data entry

Microsoft Word

Microsoft Excel

Phone etiquette

Medical terminology

Communication skills

Team work

Time management

Education

High School Diploma or equivalent

3 years retail or hospital pharmacy experience

1 year managed care prior authorization experience

Job description

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

The role emphasizes accurate data handling, timely communication with providers, and collaboration with case managers to support Medicaid/Marketplace programs. Some shifts may include evenings or weekends as needed.