Remote Prior Authorization Pharmacy Tech I

Florida Cancer Specialists & Research Institute (FCS); Florida; Remote; USD 42,000 - 58,000; Full time

Benefits offered by this job

Tuition reimbursement

401K match

Pet insurance

Legal insurance

Job summary

Florida Cancer Specialists & Research Institute is seeking a Prior Authorization Specialist to perform prior authorizations and appeals for oral oncology and supportive medications, interacting with patients, caregivers, and healthcare providers to track prescription status.

The specialist will assist the pharmacy staff and other health care professionals in supporting prescription processing to ensure prompt service and quality patient care.

Qualifications

• High school diploma or GED required.
• Active Florida Pharmacy Technician license and state of residence required.
• Active National Pharmacy Technician Certification required.
• Prior Authorization Certified Specialist (PACS) certification preferred.
• Minimum three (3) years' experience in health care or customer service, preferably pharmacy or call center.
• Hematology/oncology experience preferred.

Responsibilities

• Demonstrates effective communication skills and premier customer service to successfully interact with all levels of internal and external parties to convey information correctly.
• Performs clinical reviews of patients' charts using appropriate criteria to complete prior authorizations.
• Process appeals for prior authorization denials according to specific insurance plan requirements, provides documentation and composing a letter of medical necessity as appropriate.
• Obtain prior authorization approvals utilizing online authorization sites (ex: Eviti, New Century Health, Cover My Meds) and prior authorizations via fax and phone.
• May require interpretation or clinical data deviation from standard procedures.
• Escalate complex clinical concerns to the appropriate clinician with a goal of first call resolution.
• Comply with all accreditation standards, federal and state laws and regulations pertaining to patient privacy, patient's rights, personnel law, safety, labor, and employment law. Adhere to Company and departmental policies and procedures, including IT, HR, and compliance policies and procedures and Disaster Recovery Plan.
• Participate in the pharmacy's Continuous Quality Improvement (CQI) program by identifying and reporting quality related events.
• Additional tasks as needed to support the team and FCS.

Skills

Analysis & Critical Thinking

Interpersonal Skills

Time Management

Collaboration

Negotiation

Education

High School Diploma or GED

Florida Pharmacy Technician License

National Pharmacy Technician Certification

Job description

Florida Cancer Specialists & Research Institute is seeking a Prior Authorization Specialist to perform prior authorizations and appeals for oral oncology and supportive medications, interacting with patients, caregivers, and healthcare providers to track prescription status.

The specialist will assist the pharmacy staff and other health care professionals in supporting prescription processing to ensure prompt service and quality patient care.