Prior Authorization Technician

Position Summary

The technician shall be responsible for the authorization process of orders coming into the Pharmacy from clinics.

Key Responsibilities

• Prior and REMS Authorizations: Submit prior authorizations on behalf of physicians, follow up on submitted PA requests, monitor each PA through the process until approved/denied, and inform patient, staff and clinic as indicated. Assist clinicians in obtaining Celgene authorization and confirmation numbers.
• Appeals: Review and initiate prior authorization appeal services including first level appeal reviews. Coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required.
• Pharmacy Support: Monitor daily activities and provide backup support where needed, including PAP, SP follow-ups, BV and claims adjudication as needed.
• Education & Training: Keep up on all applicable training and education for maintenance of permit. Train staff on PA processes.
• Customer Service: Handle incoming and outgoing calls/emails to patients. Route calls to appropriate staff. Answer patient/clinic questions regarding delivery status, Rx updates, etc. Follow up on SP to assure orders are being processed efficiently. Schedule deliveries.

Requirements

• High school diploma, GED or equivalent education
• Minimum of two years' experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred
• Medical terminology and attention to detail required
• Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills
• Detail oriented with ability to exercise independent judgment
• Developed interpersonal skills, emotional intelligence, diplomacy, and conflict management
• Effective communication skills (oral, written, presentation)
• Strong customer focus and ability to work independently with limited supervision
• Self-motivated and self-starter with ability to work remotely effectively