Prior Authorization Review Pharmacy Technician

MetroPlusHealth; New York (NY); On-site; USD 60,000 - 80,000; Full time

Job summary

MetroPlus Health is hiring a Prior Authorization Review Technician to input, review, and notify on prior authorization requests, and manage medication overrides in the adjudication system. The role supports the Pharmacy department and requires strong clerical and analytical skills.

Responsibilities include answering member and provider inquiries, auditing overrides, and contributing to quality improvement initiatives. Hybrid work option with 9:00 AM–5:00 PM shifts is available.

Qualifications

• Associate's degree and 3 years of Pharmacy Technician experience, or high school diploma/GED with 5 years in Pharmacy Tech.
• Pharmacy experience in a managed care environment preferred.
• Auditing experience preferred.
• Experience with government programs (Medicare, Part D, Medicaid) preferred.
• Proficiency in Microsoft Word, Excel, and PowerPoint required.
• Proficiency in Microsoft Access preferred.

Responsibilities

• Input all received medical and pharmacy benefit prior authorization requests.
• Review select prior authorization requests and provide recommendations.
• Answer inquiries from members, providers, pharmacies, and stakeholders.
• Provide verbal notification of prior authorization decisions and enter medication overrides.
• Perform audits of vendor-entered medication overrides.
• Assist with pharmacy case management activities.
• Support departmental quality improvement initiatives.
• Answer triaged inquiries related toMetroPlusHealth pharmacy and medical benefits.

Skills

Integrity and Trust

Customer Focus

Functional/Technical Skills

Teamwork

Time management

Excellent written and verbal skills

Education

Associate's degree

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Access

Job description

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview:

The Prior Authorization Review Technician is responsible for inputting, providing notification for and reviewing prior authorization requests. The Prior Authorization Review Technician is also responsible for entering and auditing overrides input in the Pharmacy Adjudication system, answering member inquiries and assisting in all relevant Pharmacy department deliverables.

Work Shifts

9:00 AM - 5:00 PM

Duties & Responsibilities

• Inputs all received medical and pharmacy benefit prior authorization requests into processing platforms, ensuring the accurate transcription of all information.
• Reviews select prior authorization requests and provide recommendations in accordance with internal guidelines and review criteria.
• Answers inquiries from members, providers, pharmacies, and other stakeholders received through the pharmacy call center.
• Provides verbal notification of prior authorization decisions and enters accurate medication overrides into the pharmacy adjudication platform.
• Performs audits of vendor-entered medication overrides in the pharmacy adjudication platform.
• Assists with pharmacy case management activities.
• Supports departmental quality improvement initiatives.
• Answers all triaged inquiries related to MetroPlusHealth pharmacy and medical benefits.

Minimum Qualifications

• Associate's degree and 3 years of experience as a Pharmacy Technician required; bachelor's degree preferred.
• Or, a high school diploma/GED and 5 years of experience as a Pharmacy Technician required.
• Pharmacy experience in a managed care environment preferred.
• Auditing experience preferred.
• Experience with government programs, including Medicare, Medicare Part D, and Medicaid, preferred.
• Proficiency in Microsoft Word, Excel, and PowerPoint required.
• Proficiency in Microsoft Access preferred.

Licensure and/or Certification Required:

• Pharmacy Technician Certification Board (PTCB) or ExCPT Pharmacy Technician Certification, required

Professional Competencies:

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

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