Prior Authorization Technician

American Oncology Network; Fort Myers (FL); On-site; USD 26,000 - 43,000; Full time

Job summary

American Oncology Network is seeking a Pharmacy Technician to manage authorization processes for orders from clinics. You will submit prior authorizations, monitor progress, and inform patients and clinics of status.

Responsibilities include appeals, backup to pharmacy staff, staff training, and handling delivery scheduling. A high school diploma is required, with preferred experience in Retail/Specialty/Hospital Pharmacy and Florida technician registration.

Qualifications

• High school diploma or equivalent required.
• Experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail required.

Responsibilities

• Submit prior authorizations on behalf of physicians and monitor progress.
• Follow up on PA requests and inform staff and clinics as needed.
• Assist clinicians with Celgene authorization and confirmation numbers.
• Review and initiate prior authorization appeals as required.
• Provide backup support for PAP, SP follow-ups, BV and claims adjudication.
• Train staff on PA processes and maintain permit-related education.
• Handle patient and clinic inquiries regarding delivery, Rx status and scheduling deliveries.

Skills

PA authorizations

Communication

Customer service

Time management

Attention to detail

Problem solving

Remote work adaptability

Education

High school diploma / GED

Tools

MS Office (Word, Excel, PowerPoint, Outlook)

Job description

Location:

AON Pharmacy

Pay Range:

$18.93 - $31.56

Position Summary:

The technician shall be responsible for the authorization process of orders coming into the Pharmacy from clinics

Key Performance Areas:

KPA 1 – Prior and REMS Authorizations

• Submit prior authorizations on behalf of physicians
• Follow up on submitted PA requests when no response is received
• Monitor each PA through the process until approved/denied, and inform patient, staff and clinic as indicated.
• Responsible for assisting the clinicians in obtaining Celgene authorization and confirmation numbers.

KPA 2 – Appeals

• Will review and initiate prior authorization appeal services to include first level appeal reviews. Will coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required.

KPA 3 – Backup to pharmacy staff

• Will monitor daily activities and provide backup support where needed, including PAP, SP follow-ups, BV and claims adjudication as needed.

KPA 4 – Education & Training

• Responsible for keeping up on all applicable training and education for maintenance of permit.
• Will train staff on PA processes.

KPA 5 – Customer Service

• Incoming and outgoing calls/emails to patients. Routing of calls to appropriate staff. Answering patient/clinic questions regarding delivery status, Rx updates, etc.
• SP follow-up to assure orders are being processed efficiently.
• Scheduling deliveries.

Position Qualifications/Requirements:

Education : High school diploma, GED or equivalent education is required

Previous Experience : Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail required.

Core Capabilities :

• Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.
• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
• Communication Skills: Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.
• Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.
• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.
• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.
• Computer Skills:
  • Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

Certifications/Licenses :

• Pharmacy technician registration with the Florida Dept of Health in good standing required.
• Valid state Driver’s License for travel to satellite offices and offsite meetings. Compliance with the company Driver Safety Operations and Motor Vehicle Records Check Policy is required.

Travel : 0%

Standard Work Days/Hours : Monday to Friday 9:00 AM – 5:30 PM.

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