Prior Authorization Specialist I

MedImpact Healthcare Systems, Inc.; San Diego (CA); Hybrid; USD 24,000 - 38,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off / Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. is seeking a Pharmacy Technician to join the Prior Authorization Operations team.

This role processes prior authorization requests, analyzes clinical guidelines, and uses various systems to ensure accurate, timely determinations for claims adjudication. You will interact with physicians, pharmacies, and members, providing information and ensuring high-quality service while following client guidelines and protocols.

Qualifications

• GED/HS Diploma and 1+ year experience or equivalent combination of education and experience.
• Must successfully complete one of the national certification exams OR obtain state licensure (in any U.S. State).
• Maintains a current Pharmacy Technician License and/or CPhT certification.

Responsibilities

• Process and finalize Prior Authorization (PA) requests within clients’ turnaround time and Performance Guarantees utilizing guidelines.
• Enter PAs into the system and prioritize requests; check formulary alternatives and review tried and failed medications.
• Coordinate notifications to members, physicians, and pharmacies to obtain missing information and communicate prior authorization determinations.
• Collaborates with clinical pharmacists to ensure adherence to boundaries and timeframes of administrative processing.
• Protects and maintains confidentiality and privacy of all prior authorization information.

Skills

Prior Authorization processing

MS Office

Excel

Outlook

Education

GED/HS Diploma

Tools

Windows databases

Job description

MedImpact Healthcare Systems, Inc. is seeking a Pharmacy Technician to join the Prior Authorization Operations team.

This role processes prior authorization requests, analyzes clinical guidelines, and uses various systems to ensure accurate, timely determinations for claims adjudication. You will interact with physicians, pharmacies, and members, providing information and ensuring high-quality service while following client guidelines and protocols.