Remote PBM Pharmacy Tech - Prior Authorization Specialist

Actalent; Dallas (TX); Remoto; USD 28.000 - 32.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental & vision

401(k)

Paid time off

Descrizione del lavoro

Actalent is seeking a Pharmacy Technician for a contract role based in Dallas, TX, with fully remote work options. You will track and triage coverage determination requests for prior authorizations and Medicare Part D recipients, review requests, gather clinical information, and document decisions in the PBM system while communicating clearly with providers and members.

The role requires at least 1 year of pharmacy experience, a current state Pharmacy Technician license, and familiarity with PBM

Competenze

• High school diploma or equivalent.
• 1 year experience in a retail, hospital, or mail order pharmacy setting.
• Current state Pharmacy Technician license.
• Experience handling prior authorization or coverage determination processes in a pharmacy or PBM environment.
• Ability to track and triage coverage determination requests efficiently.
• Skill in obtaining verbal authorizations and requesting detailed clinical information from prescribers.
• Ability to approve coverage determinations based on defined criteria and guidelines.
• Proficiency in documenting decisions in a PBM system.
• Strong communication skills to notify providers and members of coverage decisions and respond to client inquiries.
• Attention to detail and accuracy in data entry and recordkeeping.

Mansioni

• Track and triage all coverage determination requests submitted by providers for prior authorizations and Medicare Part D recipients.
• Review coverage determination requests and determine when a pharmacist review is required based on established guidelines.
• Obtain verbal authorizations from prescribers and request detailed clinical information to support coverage determinations.
• Approve coverage determination requests in accordance with defined criteria and organizational policies.
• Enter and document coverage determination decisions accurately in the PBM system.
• Notify providers and members of coverage determination decisions in a timely and professional manner.
• Respond to client inquiries regarding authorization approvals and PBM online processes.
• Refer coverage determination requests for specialty drugs to the appropriate delegated vendor or client for processing.
• Contact providers to obtain additional information needed to complete coverage determination reviews.
• Maintain thorough and accurate records of all interactions and decisions related to coverage determination requests.

Conoscenze

Prior authorization

PBM systems

Verbal authorizations

Pharmacy experience

Attention to detail

Communication skills

Formazione

High school diploma or equivalent

Pharmacy Technician license

CPhT preferred

Strumenti

PBM online tools

Descrizione del lavoro

Actalent is seeking a Pharmacy Technician for a contract role based in Dallas, TX, with fully remote work options. You will track and triage coverage determination requests for prior authorizations and Medicare Part D recipients, review requests, gather clinical information, and document decisions in the PBM system while communicating clearly with providers and members.

The role requires at least 1 year of pharmacy experience, a current state Pharmacy Technician license, and familiarity with PBM