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Pharmacy Prior Authorization Technician
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- Reviews and interprets prescription and medical benefit coverage across all lines of business including Medicare D to determine what type of prior authorization review is required, documents any relevant medication history and missing information to assist the pharmacist/nurse/physician in the review process.
- Contacts pharmacies and physician offices as necessary to obtain clarification on prior authorization requests and drugs being billed through the point-of-sale system and/or medical claim system in order to optimize the member experience.
- Acts as a lead troubleshooter for the pharmacy help desk, customer care and claim processors to coordinate pharmacy and/or medical claims with prior authorization information on file or needed for the member.
- Acts as a content expert for prior authorization intake for our customers, both internal and external.
- Serves as lead liaison for the prior authorization process and its interface to the pharmacy and medical claim systems to troubleshoot.
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