Prior Authorization Coordinator / Pharmacy Technician (MST / PST candidates only!)

Insight Global; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

Insight Global is seeking a Prior Authorization Coordinator / Pharmacy Technician to work remotely. The role involves processing prior authorization requests, ensuring accuracy and timeliness while interacting with clients and healthcare providers. Candidates must have at least one year of experience and an active Pharmacy Technician certification.

Benefits

Medical insurance

Vision insurance

401(k)

Paid sick leave

Paid time off benefits

Qualifications

• 1+ year of experience as a Pharmacy Technician.
• Strong experience with prior authorizations.
• Active Pharmacy Technician certification (national certification or state licensure).

Responsibilities

• Process prior authorization requests in accordance with standards for accuracy and timeliness.
• Interact with internal and external customers to provide and obtain information.
• Document all related information regarding the PA approval or non-approval.

Skills

Strong data entry skills

Attention to detail

Strong experience with prior authorizations

Experience with inbound/outbound calls

Intermediate knowledge of MS Office/Word, Excel, and Outlook

Education

Active Pharmacy Technician certification

Job description

Prior Authorization Coordinator / Pharmacy Technician (MST / PST candidates only!)

Prior Authorization Coordinator / Pharmacy Technician (MST / PST candidates only!)

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This range is provided by Insight Global. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$20.00/hr - $23.50/hr

Candidates must reside in one of the following states to be considered;

• Arizona
• California
• Idaho
• New Mexico
• Utah
• Washington

**Candidates outside of these states ^ unfortunately cannot be considered for this opportunity**

POSITION DETAILS:

Location: Remote

Shifts: 8 hour shifts ranging between 5AM-11PM MST Mon-Sun

Must-haves:

• 1+ year of experience as a Pharmacy Technician
• Active Pharmacy Technician certification (national certification or state licensure)
• Strong experience with prior authorizations
• Experience with inbound/ outbound calls
• Strong data entry skills and attention to detail
• Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs
• Experience with Windows based database programs

Plusses (but NOT required):

• Experience with Cisco Finesse phone system

Position Summary

• Works as a member of the Prior Authorization Operations team.
• Processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.
• Uses various business applications (MedResponse, MedAccess, FileNet, RightFax, etc.) to perform analysis, obtain information, and enter prior authorization data necessary for claims adjudication.
• Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based upon clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).
• Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.

Essential Functions and Responsibilities:

• Process and finalize PA requests within clients’ turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines.
• Enter prior authorizations (Pas) into the system and prioritize requests.
• Check formulary alternatives, review tried and failed medications, apply Prior Authorization Guidelines.
• Utilize drug references and verify the drug being requested is indicated and approved for the condition.
• Document all related information regarding the PA approval or non-approval.
• Respond to incoming requests via phone, fax, ePA and returning status of the PA to the physicians and pharmacies.
• Conforms to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision making.
• Partners with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Accountable to achieve prior authorization processing productivity and accuracy standards.
• Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career path level, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from team subject matter experts (SME) or supervisor; and referring unique or high dollar requests to supervisor according to guidelines.
• Coordinates notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations.
• Documents prior authorization related information and status. Makes outbound calls to obtain information and answer questions about prior authorization status.
• Collaborates with MCO and Self-Insured client teams to understand PBM clients’ prior authorization processing requirements and expectations. As appropriate for experience and career path level, partners with client teams to complete special prior authorization processing projects and provide accurate, timely, and reliable information to client claim inquiries.
• Collaborates with Contact Center Services in resolving prior authorization inquiries and handling incoming calls during periods of high volume.
• Protects and maintains confidentiality and privacy of all prior authorization and member information, including following strict protocols for date stamping and storage/security of prior authorization forms and related information.

Compensation:

$20/hr to $23.50/hr.

Exact compensation may vary based on several factors, including skills, experience, and education.

Employees in this role will enjoy a comprehensive benefits package starting on day one of

employment, including options for medical, dental, and vision insurance. Eligibility to enroll in

the 401(k) retirement plan begins after 90 days of employment. Additionally, employees in this

role will have access to paid sick leave and other paid time off benefits as required under the

applicable law of the worksite location.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

Referrals increase your chances of interviewing at Insight Global by 2x

Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

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