Pharmacy Technician II: Prior Authorization Specialist

CareSource; Indiana; Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Total rewards package

Job summary

CareSource is seeking a Pharmacy Technician II to support prior authorization processes, data entry, and provider/pharmacy communications. You will review traditional and specialty requests and help resolve escalations in the pharmacy department.

Role requires strong phone and document management, familiarity with Medicaid/Marketplace, and ability to work independently or within a team. Equal opportunity employer.

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 prior authorization requests for traditional and specialty medications.
• 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.
• Perform outbound calls to obtain information from providers and/or pharmacies.
• Document all telephonic interaction in appropriate system(s).
• Ensure inquiries and submissions are answered within 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 knowledge of all processes for all markets on faxes and phones.
• Adhere to all departmental and company policies and procedures.

Education

High School Diploma or equivalent

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

CareSource is seeking a Pharmacy Technician II to support prior authorization processes, data entry, and provider/pharmacy communications. You will review traditional and specialty requests and help resolve escalations in the pharmacy department.

Role requires strong phone and document management, familiarity with Medicaid/Marketplace, and ability to work independently or within a team. Equal opportunity employer.