Remote Prior Authorization Specialist I

Techlink Systems Inc.; Philadelphia (Philadelphia County); Remote; USD 42,000 - 62,000; Full time

Job summary

Techlink Systems Inc. seeks a Prior Authorization Technician I to process requests from providers, members, and pharmacies, including high-cost and specialty medications. You will interpret criteria, use claims history, and make outbound calls to gather information.

This remote role offers EST shift times and requires High School/GED and a PTCB/NHA certification, with occasional weekend availability and ability to multitask.

Qualifications

• High School/GED required; professional certification preferred.
• PTCB or NHA certification; licensure may be required by contract.
• Shift schedule outside standard business hours required.
• Must remain in stationary position at desk/computer for long periods.
• Requires occasional moving around office and lifting up to 10 pounds.

Responsibilities

• Interprets and applies clinical criteria during prior authorization reviews and approves requests when applicable.
• Uses member claims history during the prior authorization review process.
• Makes outbound calls to obtain additional information needed to process requests.
• Submits authorizations to pharmacy and medical claims processors.
• Forwards requests to pharmacists when necessary and directs to in-network providers.
• Receives inbound calls related to prior authorization inquiries and assists in Appeals processing.

Skills

Prior Authorization Processing

Clinical Criteria Interpretation

Member Claims History Utilization

Outbound Calling

Authorization Submission

Typing 35 WPM

PBM Experience

Education

High School/GED

Certified Pharmacy Technician (PTCB or NHA)

Job description

Techlink Systems Inc. seeks a Prior Authorization Technician I to process requests from providers, members, and pharmacies, including high-cost and specialty medications. You will interpret criteria, use claims history, and make outbound calls to gather information.

This remote role offers EST shift times and requires High School/GED and a PTCB/NHA certification, with occasional weekend availability and ability to multitask.