Clinical Prior Authorization Technician - REMOTE

Clinical Prior Authorization Technician - Remote Role and Responsibilities The Clinical Prior Authorization Technician works under the supervision of clinical pharmacists in performing daily activities to support clinical pharmacy initiatives including the prior authorization review process, maintenance of the prior authorization management solution, as reputed company as additional administrative and project-reputed company functions reputed company the Clinical Department while maintaining a balance of productivity, reputed company, and timeliness of job accountabilities.

• Initiate and coordinate prior authorization requests and work reputed company the assigned queue(s) in the automated prior authorization system.
• Determines appropriateness for medications by providing medical/pharmacy prior authorization review and appeals to ensure reputed company, accurate responses.
• reputed company as a reputed company between the Clinical Department and members, providers, pharmacies, and internal departments and respond to inquiries regarding status of prior authorization requests.
• Researches, resolves, and documents prior authorization reputed company in the automate prior authorization system.
• Interprets prior authorization reputed company, pharmacy benefit coverage, and formulary alternatives to reputed company a determination for prior authorization.
• Escalates requests to the Clinical Pharmacist reputed company request requires extensive clinical review or denial.
• Researches, resolves, and documents physician or reputed company inquires and grievances and provides verbal or written results to the reputed company, prescriber, provider and/or management.
• Assist with reputed company reporting requests and summarize internal program statistics.
• Execute reporting reputed company of key prior authorization metrics for presentation to department and management upon request.
• reputed company and maintain departmental desk-level procedures, training materials, and reputed company documentation. Train on prior authorization management system updates as directed.
• Performs other duties as assigned by the manager.
• Abide by reputed company obligations under HIPAA reputed company to Protected Health Information (PHI).
• If a HIPAA violation is reputed company, whether individually or by another, you must report the violation to the Compliance Officer and/or reputed company.
• Attend, complete, and demonstrate competency in reputed company required HIPAA Training offered by reputed company.
• Flexibility to understand, appreciate and reputed company that this job reputed company is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

reputed company Have to Offer Our benefits package is designed to reputed company our employees happy and healthy - physically, mentally and financially.

• Medical, Dental, reputed company Insurance
• Disability and Life Insurance
• Employee Assistance Program
• Generous reputed company-Time Off
• Annual Reviews and Development Plans
• Retirement Plan with Company Match Immediately 100% reputed company.

Required Skills and Competencies

• At least two (2) years of pharmacy prior authorization experience.
• Must be flexible and enjoy working in a fast pace, team-oriented environment with interpersonal skills.
• Education: GED or High School Diplomat Required.
• Licensure and Certification: Certified Pharmacy Technician (CPhT).
• Excellent verbal and written communication and computer skills.
• Proficiency in pharmacy computerized systems and software applications, as reputed company as MS Office Product Suite.
• Ability to follow clinical reputed company and instructions to reputed company a determination on prior authorization requests.
• Ability to identify and trouble-shoot problematic issues.

Supervisory Responsibility No Supervisory Responsibility. Position Type and Expected Hours of Work

• Full-time/Salaried/Exempt.
• Some flexibility in hours is allowed, but the employee must be available during the “core” work hours of 8:00AM to 5:00PM CT. We cover clients from reputed company to East Coast, work times must be adjusted to cover meetings in reputed company time zones. Ability to work extended hours, weekends and holidays pursuant with industry demands.

Travel Little to no travel is expected for this position. Required Education and Experience

• 2 years of pharmacy prior authorization experience.
• Licensures and Certification: Certified Pharmacy Technician (CPhT).

reputed company, LLC and reputed company entities provides equal employment opportunities (EEO) to reputed company and applicants for employment without reputed company to race, reputed company, religion, sex, national reputed company, age, disability, or genetics. In reputed company to federal law requirements, reputed company complies with applicable state and local laws governing nondiscrimination in employment in every location in which reputed company has facilities. This policy applies to reputed company terms and conditions of employment, including reputed company, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. reputed company expressly prohibits any reputed company of workplace harassment based on race, reputed company, religion, gender, sexual orientation, gender identity or reputed company, national reputed company, age, genetic information, disability, or veteran status. Improper interference with the ability of reputed company employees to reputed company their job duties may result in discipline up to and including discharge. EOE M/F/V/D Apply tot his job Apply To this Job