Pharmacy Prior Authorization Coordinator I

3 weeks ago

Richmond, United States Sentara Healthcare Full time

**Sentara Health** is currently recruiting for a **Full-Time, Remote**

**Pharmacy Prior Authorization Coordinator I in Richmond or Tidewater, VA area**.

Under the direct supervision of a Pharmacy Team Coordinator, the pharmacy prior authorization coordinator (PAC) is responsible for supporting the Pharmacy Department's day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial).

This position handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution. The PAC also uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist. The position will be an internal resource interfacing with members, providers, and internal departments' personnel to resolve pharmacy claims and prior authorization issues.

**Job Requirements**
- High School Grad or Equivalent
- Certified Pharmacy Technician (CPhT)
- NHA Pharmacy Technician Certification (CPhT)
- Pharmacy Technician 1 year required
- Pharmacy Call Center or Authorization experience preferred
- Managed Care, Health Plan or PBM experience preferred
- State Registration required based on location, VA or NC

**Benefits**: Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more. Sentara recognizes our employees by offering:

- Comprehensive health care plans
- Generous paid annual leave
- 401a/401k/403b plan
- Long and short-term disability
- Tuition Reimbursement
- Flex spending and life insurance
- You can expect employee recognition, performance rewards, plus countless services and programs to enhance work/life balance.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day, join the Sentara Team

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and

growth.

keywords: pharmacy technician, managed care, health plan, Indeed, Monster

Under the direct supervision of a Pharmacy Team Coordinator, the pharmacy prior authorization coordinator (PAC) is responsible for supporting the Pharmacy Department's day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial). At a minimum, the PAC provides knowledgeable and courteous customer service and response to members and providers. This position handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution. The PAC also uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist. This position will be an internal resource interfacing with members, providers, and internal departments' personnel to resolve pharmacy claims and prior authorization issues.The Pharmacy Prior Authorization Coordinator will be able to accept ownership for effectively solving member or provider issues, complaints, and inquiries, keeping member satisfaction at the core of every decision and behavior.
- Pharmacy Technician Certification (CPhT) - Certification - National Healthcareer Association (NHA)
- Certified Pharmacy Technician (CPhT) - Certifications - Pharmacy Technician Certification Board (PTCB)

**Description**

**Sub-Competency**

**Takes initiative to problem solve pharmacy related inquiries**
- Demonstrates effective problem-solving skills to ensure timely resolution of pharmacy issues including eligibility, network concerns and other related claims processing issues.
- Distinguishes between routine and significant matters; apprises management of issues which can negatively affect service and business.
- Identifies provider/physician/member issues and refers to appropriate departments
- Assists Pharmacy department efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies
- Proactively develops an understanding of existing pharmacy key issues and business requirements and works with internal team to meet business requirements
- Maintains a current knowledge base of program services, policy, and procedures

**Assist customers in call center operations**
- Strive to provide quality first call resolution for incoming calls from prescribers, members and/or pharmacies
- Must complete and successfully pass 100% of all required SHP computer-based modules
- Resolves customer complaints, concerns, and inquiries as the first line of contact; suspe

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