The essential functions of a pharmacy technician in Prior Authorization are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non-formulary medications, while ensuring a high level of customer service and maximizing productivity. Request can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.
¿ Using established criteria and guidelines, the pharmacy technician receives and processes prior authorization requests made by providers and members for medications not inherently covered on a member's prescription drug plan.
¿ Answer prior authorization inquiry calls or/and faxes as well as research and resolve formulary and benefit issues using the appropriate reference material.
¿ Resolve issues and complaints in a timely manner.
¿ Performs other duties as assigned by management.
¿ Handles inbound phone requests and gathers member data to provide information for Pharmacist consultations.
¿ Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
¿ Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
Shift: 8 hr shift must be available between 5am-10pm PST M-F, Saturday and Holidays.
Training time is 8:00am-5:00pm. Monday- Friday. (This training time is subject to change)
Candidate will work 5 days a week which may or may not include a weekend day(s).
Dependent on business needs, there may be required Overtime and Holidays.
Excellent attendance is a must.
¿ CA you can have either your national certification or your state.
¿ High School Diploma or GED is required
¿ Associate's degree or 3-5 years of equivalent work experience is preferred
¿ 1 - 3 years of previous experience as a Pharmacy Technician is preferred
¿ 1 year of customer service experience analyzing and solving customer problems, OR 1 year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties is preferred.
¿ 1 to 3 years of PC skills (MS Word, Excel) proficiency is preferred
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