Pharmacy Utilization & Prior Authorization Specialist

ATD Technology LLC; Newark (NJ); On-site; USD 55,000 - 75,000; Full time

Job summary

ATD Technology LLC in Newark, New Jersey, is seeking a Pharmacy Specialist Level 1 to manage prior authorizations and support Pharmacy Services activities, including claim utilization analysis, plan design, ad-hoc reporting, and correspondence.

You will interact with physicians, pharmacies, and patient care teams to determine medical necessity, streamline formulary compliance, and assist in Medication Therapy Management programs, with a focus on accuracy and regulatory compliance.

Qualifications

• Bachelor's degree preferred in Health Care Management, Business or Pharmaceutical Administration.
• Minimum of two years' experience in third-party prescription program claim adjudication.
• Minimum of two years' experience as a Pharmacy Utilization Management Specialist.
• Experience in customer service or service quality initiatives.

Responsibilities

• Process prior authorizations received via help line, evaluating medical necessity.
• Interact with physicians, office staff, pharmacies and internal stakeholders for eligibility and claims issues.
• Intervene to facilitate formulary compliance and generic dispensing.
• Process appeals, complaints, executive inquiries and compliance issues.
• Provide recommendations to increase efficiency, accuracy and productivity.
• Process ad hoc information requests or reports.
• Participate in client member and employee training on pharmacy services.
• Assist in day-to-day pharmacy department operations and Medication Therapy Management programs.
• Support various clinical programs within the pharmacy department.

Skills

Prior authorization processing

Customer service

Pharmacy operations

Interpersonal communication

Education

Bachelor's degree in Health Care Management, Business or Pharmaceutical Administration

Job description

ATD Technology LLC in Newark, New Jersey, is seeking a Pharmacy Specialist Level 1 to manage prior authorizations and support Pharmacy Services activities, including claim utilization analysis, plan design, ad-hoc reporting, and correspondence.

You will interact with physicians, pharmacies, and patient care teams to determine medical necessity, streamline formulary compliance, and assist in Medication Therapy Management programs, with a focus on accuracy and regulatory compliance.