Prior Authorization Technician II

WellDyne; United States; Remote; USD 29,000 - 41,000; Full time

Benefits offered by this job

Medical, Dental and Vision Benefits

401K after 90 days

Educational Reimbursement

Paid Time Off

Career Pathing

Job summary

WellDyne is seeking a Prior Authorization Tech II for a fully remote role. You will initiate clinical prior authorization requests by telephone or email, create and fax cases for PA, and maintain complete, timely documentation; you will also resolve PA questions with prescribers, pharmacies and members.

This position requires strong telephone, verbal and written communication, customer service, multitasking, and MS Office proficiency; business hours follow MST or EST.

Qualifications

• Pharmacy Technician Certification strongly preferred or must obtain PTCB within 6 months.
• Active state technician registration as required by state.
• At least 2 years of pharmacy-related experience.
• At least 2 years of customer service-related experience.
• MS Office Suite knowledge and ability to learn new systems.

Responsibilities

• Start clinical PA requests via telephone or email.
• Create and fax cases for prior authorization with complete documentation.
• Complete PA requests via telephone with prescriber staff as needed.
• Collaborate with pharmacies, providers and members to resolve PA questions.
• Respond promptly to inquiries regarding administrative prior authorizations.
• Follow policies and ensure confidentiality of PHI.
• Meet productivity, schedule adherence and quality standards.

Skills

Strong telephone skills

Verbal communication

Written communication

Customer service principles

Time management

MS Office proficiency

Teamwork and collaboration

Multi-tasking

Independent work in team

Education

Pharmacy Technician Certification

Active technician registration

2+ years pharmacy experience

Tools

MS Office Suite

PHI handling procedures

Job description

This position is fully remote. The required working schedule is 8:00 AM – 5:00 PM Mountain Time (MST) or 10:00 AM – 7:00 PM Eastern Time (EST), depending on business needs and your time zone.

Summary

The Prior Authorization Tech II is responsible for starting all clinical prior authorization requests via telephone or email, which includes creating and faxing cases for prior authorization while maintaining complete, timely and accurate documentation of all requests. Individuals will also complete PA requests via telephone with appropriate staff at the prescriber’s office. Individuals also work closely with pharmacies, providers, and members to resolve any questions or issues involving prior authorizations while maintaining confidentiality of all PHI. This position requires strong telephone, verbal and written communication skills, knowledge of customer service principles and practices, and time management skills with the ability to multi-task. Individuals must also be proficient in Microsoft applications.

Essential Duties and Responsibilities

• Responsible for starting clinical prior authorization requests via telephone or email.
• Support prior authorization call center via administrative and clinical prior authorization support lines.
• Creates and faxes cases for prior authorization, maintaining complete, timely and accurate documentation of all prior authorization requests.
• Completes prior authorization request via telephone with appropriate staff at prescriber’s office by answering questions based on protocols when possible.
• Works closely with pharmacies, providers, and members to resolve any questions or issues involving prior authorizations.
• Responds in a prompt, professional, and courteous manner to pharmacy, provider and member inquiries regarding administrative prior authorizations.
• Ability to clearly identify problems, analyze situations, and rectify pharmacy, provider, or member concerns using established procedures.
• Ability to handle difficult people and problems by resolving matters in an effective and timely manner.
• Responsible for clearing and following up on all messages left on prior authorization voicemail box in a timely manner.
• Apply appropriate policies, procedures, and eligibility and benefit policies.
• Maintains confidentiality of all PHI in compliance with state and federal law.
• Consistently meets established productivity, schedule adherence, and quality standards, while maintaining a good attendance record.
• Other duties as assigned.

Education and Experience

• Pharmacy Technician Certification strongly preferred or must be committed to obtaining PTCB Certification within 6 months of position start date
• Technician registration that is active and in good-standing, as applicable based upon state requirements for technicians
• At least 2 years of pharmacy related experience
• At least 2 years of customer service-related experience
• MS Office Suite knowledge (Which includes the ability to learn new and complex computer system applications)

Knowledge, Skills, and Abilities

• Strong telephone, verbal, and written communication skills
• Knowledge of customer service principles and practices
• Time Management Skills
• Teamwork and team building skills
• Ability to work independently within a team environment with little direct supervision
• Ability to work in a high pace, stress environment
• Ability to remain focused and productive each day though tasks may be repetitive
• Strong attention to detail and effective follow-up skills
• Ability to multi-task
• Claim system knowledge
• Positive attitude with excellent customer service mindset demonstrating WellDyneRx commitment to incredible service
• Computer proficiency to navigate required databases and operate in required software packages
• Working with people with a strong desire to help resolve problemsAbility to work under pressure
• Creative problem solver and effective at conflict resolution
• Ability to sit at a computer using a phone and headset for length of shift with breaks and lunch away from desk assigned per length of given shift
• Demonstrated ability to handle problems tactfully

Remote Work Requirements

• To ensure effective performance in a remote environment, all candidates must meet the following technical and workspace requirements:
• Internet Speed: Minimum of 100 Mbps download / 10 Mbps upload, verified by HR through a speed test
• Connectivity: Must be able to connect using a hard-wired Ethernet connection (modem/router must be within 10 feet to allow for a wired setup)
• Phone Access: A mobile device is required to receive VPN push notifications and for system support
• Workspace: A dedicated, quiet workspace that minimizes background noise and distractions

WellDyne Can Offer You

• Medical, Dental and Vision Benefits
• Medical Savings Account Options with Company match
• 401K after 90 days of employment
• Employee Assistance Program
• Life and Supplemental insurance
• Educational Reimbursement
• Paid Time Off
• Career Pathing

Base Salary Range: $28,700-$40,900

In accordance with applicable state and federal laws, the range provided is WellDyne's reasonable estimate of the base compensation for this role. The actual amount may differ based on non-discriminatory factors such as experience, knowledge, skills, abilities, and location. Base pay is one part of the total package that is provided to compensate and recognize employees for their work, and this role may be eligible for additional discretionary bonuses/incentives, and equity in the Company.

Work Environment / Physical Demands

This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.