Prior Authorization Technician

Location Remote Position Pay Range $18.93 - $31.56 Position Summary The technician shall be responsible for the authorization process of orders coming into the Pharmacy from clinics Key Performance Areas KPA 1 – Prior and REMS Authorizations

• Submit prior authorizations on behalf of physicians
• Follow up on submitted PA requests when no response is received
• Monitor each PA through the process until approved/denied, and inform patient, staff and clinic as indicated.
• Responsible for assisting the clinicians in obtaining Celgene authorization and confirmation numbers. KPA 2 – Appeals
• Will review and initiate prior authorization appeal services to include first level appeal reviews. Will coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required. KPA 3 – Backup to pharmacy staff
• Will monitor daily activities and provide backup support where needed, including PAP, SP follow-ups, BV and claims adjudication as needed. KPA 4 – Education & Training
• Responsible for keeping up on all applicable training and education for maintenance of permit.
• Will train staff on PA processes. KPA 5 – Customer Service
• Incoming and outgoing calls/emails to patients. Routing of calls to appropriate staff. Answering patient/clinic questions regarding delivery status, Rx updates, etc.
• SP follow-up to assure orders are being processed efficiently.
• Scheduling deliveries. Position Qualifications/Requirements Education High school diploma, GED or equivalent education is required Previous Experience Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail required. Core Capabilities
• Analysis & Critical Thinking Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.
• Interpersonal Effectiveness Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
• Communication Skills Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.
• Customer Service & Organizational Awareness Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.
• Self-Management Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.
• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.
• Computer Skills
• Proficiency in MS Office Word, Excel, Power Point, and Outlook required. Certifications/Licenses
• Pharmacy technician registration with the Florida Dept of Health in good standing required.
• Valid state Driver’s License for travel to satellite offices and offsite meetings. Compliance with the company Driver Safety Operations and Motor Vehicle Records Check Policy is required. Travel 0% Standard Work Days/Hours Monday to Friday 900 AM – 530 PM. #LI-REMOTE Apply To This Job Apply To This Job Apply tot his job Apply To this Job

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