Prior Authorization Technician I

Duties:The Prior Authorization Technician I assists in the prior authorization process.Reports directly to the Supervisor, Prior Authorization TechniciansProcesses prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medicationsInterprets and applies clinical criteria during the prior authorization review process and approves requests if applicableUtilizes member claims history during the prior authorization review processMakes outbound calls to obtain additional information needed to process prior authorization requestsSubmits authorizations to pharmacy and medical claims processorsForwards prior authorization requests to a pharmacist when necessaryMakes appropriate referrals to other clinical programsAssists in directing appropriate requests to in network providersReceives inbound calls from the customer care center with prior authorization related inquiriesAssist with Appeals processing as assignedAbility to multitask between various tasks and systems while maintaining required productivity and quality levelsAbility to make changes in a fast paced environmentStrong knowledge of specialty and non-specialty pharmaceuticalsPerforms other job related duties and projects as assignedAttends required training on an annual basis.Adheres to corporate and departmental policies and procedures.Available to work weekends and holidays.Skills:1 to 3 YearsPrevious PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.Minimum 35 words per minute typing speed.Education:High School Diploma / GED