Prior Authorization Pharmacy Technician

Healthcare Support Staffing; Glen Ellen (CA); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Competitive salary

Medical benefits

Dental benefits

Vision benefits

Job summary

A leading health benefits company in California seeks a Pharmacy Technician for their call center. The candidate will manage 30-50 inbound calls per day, addressing prior authorization and prescription approval inquiries. Responsibilities include evaluating pharmacy requests, communicating decisions, and assisting medical staff. Applicants must have a Pharm Tech Certification or PTCB, along with experience in a retail or dispensing role. This role offers a competitive salary and benefits including medical, dental, and vision, with Monday through Friday scheduling.

Qualifications

• Must hold Pharm Tech Certification in Virginia or national certification.
• Minimum of 6 months of dispensing or retail experience.
• Knowledge of specialty injectable prescription drugs and health plan formulary management.
• Proficiency with pharmacy computer systems and MS Office Suite.

Responsibilities

• Answer 30-50 inbound calls daily from enrollees or providers.
• Evaluate and authorize prior authorization pharmacy requests.
• Communicate decisions to medical staff and document outcomes.
• Escalate complex cases to Pharmacist for clinical review or denial.
• Respond to physician or client inquiries and document results accurately.

Skills

Pharmacy computerized systems proficiency

Medical terminology

Problem-solving skills

Knowledge of prior authorization

Education

Pharm Tech Certification or PTCB

Tools

MS Office Product Suite

MS Office

Job description

Anthem, Inc. is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.

One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.

Job Description

Candidate will be working in the MagellanRX call center and will be responsible for answering around 30-50 calls per day (majority being inbound). Calls may be from enrollees, doctor offices or pharmacies and topics can include Prescription Approvals, Intiail/Prior Authorization, Claims, ID Cards, DUR (Drug Utilization Review) rejection, etc.

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers.

Essential Functions:

• Determines appropriateness for medications.
• Communicates decision to physicians, physician’s office staff, medical management staff and/or pharmacists.
• Researches, resolves and documents prior authorization outcomes in pharmacy system.
• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician’s office staff, medical management staff and/or pharmacists.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.
• Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management
• Performs other duties as required

Qualifications

• Must have either a Pharm Tech Certification(CPT) in the state of VA or have the PTCB (national certification)
• At least 6 months of dispensing or retail experience (equivalent internal training will be substituted)
• Previous reimbursement experience and/or working in a health plan/healthcare setting
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary (preferred drug list) management techniques (ability to objectively discriminate between superior and marginal medications), medical terminology and/or current diagnostic/reimbursement clinical criteria
• Knowledge of prior auth
• Ability to identify and trouble-shoot problematic issues
• Proficiency in Pharmacy computerized systems and software applications and MS Office Product Suite

Additional Information

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm