Prior Authorization Technician I

Job Title: Prior Authorization Technician I
Job Location: Philadelphia, PA 19113 (REMOTE)
Job Duration: 3-4 Months+ (possibility of extension)
 
Shift: 40 Hours Per Week/ 5 Days per week
 
Duties:

• The Prior Authorization Technician I assists in the prior authorization process.
• Reports directly to the Supervisor, Prior Authorization Technicians.
• Processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications.
• Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable.
• Utilizes member claims history during the prior authorization review process.
• Makes outbound calls to obtain additional information needed to process prior authorization requests.
• Submits authorizations to pharmacy and medical claims processors.
• Forwards prior authorization requests to a pharmacist when necessary.
• Makes appropriate referrals to other clinical programs.
• Assists in directing appropriate requests to in network providers.
• Receives inbound calls from the customer care center with prior authorization related inquiries.
• Assist with Appeals processing as assigned.
• Ability to multitask between various tasks and systems while maintaining required productivity and quality levels.
• Ability to make changes in a fast paced environment.
• Strong knowledge of specialty and non-specialty pharmaceuticals.
• Performs other job related duties and projects as assigned.
• Attends required training on an annual basis.
• Adheres to corporate and departmental policies and procedures.
• Available to work weekends and holidays.

• High School Diploma / GED.
• Certified Pharmacy Technician (PTCB or NHA) Required.

• 1 to 3 Years.
• Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
• Minimum 35 words per minute typing speed.