Pharmacy Prior Authorization Technician

3 weeks ago

Syracuse, United States PSG Global Solutions Careers Full time

Apply now and our proprietary system will quickly have you in front of a live recruiter.
The Opportunity
Description
We're looking for a Pharmacy Prior Authorization Technician, working in Insurance industry in Syracuse.

  • Conducts an initial level medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the members benefit.
  • Routes cases directly to the pharmacist/medical director for final determination, as directed.
  • Issues verbal and written member notification as required.
  • 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.
  • Develops and implements process improvement to increase efficiency in the review process for the clinical staff.
  • Works with requesting providers, clinical pharmacists, and other internal staff, as appropriate, in determining whether specific case presentation meets the criteria for approval according to the medical or prescription drug policy and specific coverage criteria.
  • Points out nuances that may not be readily apparent regarding the request.
  • 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.
  • Assures appropriate authorized entry across all lines of business.
  • Ensures care management system interfaces to claim processing system for claim payment.
  • Performs system testing as required for upgrades and enhancements to the care management system.
  • Acts as a content expert for prior authorization intake for our customers, both internal and external.
  • Serves as department subject matter expert for pharmacy and medical drug authorizations and coverage.
  • Serves as lead liaison for the prior authorization process and its interface to the pharmacy and medical claim systems to troubleshoot.
  • Triages issues to the appropriate department for resolution.
  • Triages prior authorization workflow daily by rerouting cases, alerting clinical staff of time frame deadlines, monitoring work queues and keeping management aware of issues related to compliance mandated time frames for review completion.
  • Provides phone coverage for incoming calls as required to support the UM process. This may include authorization inquiries and information requests, claim inquiries, and other related inquiries. Provides friendly, accurate and timely assistance.
  • Supports medical and pharmacy drug pricing questions, and uses drug lookup tools such as government sites, and other online resources.
  • Maintains thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff with related inquiries.
  • Performs unit specific workflow processes consistent with corporate medical & administrative policies, employer specific guidelines, and/or regulatory agencies.
  • Produces, records, or distributes information for others. On a periodic basis, tracks and reports department performance against benchmarks.
  • Prepares and assists in handling correspondence. Assures accuracy and timeliness of processing.
  • Participates in interdepartmental coordination and communication to ensure delivery of consistent and quality health care services examples include Utilization Management, Quality Management and Case Management.
  • Produces, at minimum, the team average medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the members benefit.
  • Consistently demonstrates high standards of integrity by supporting the company's mission and values, adhering to the Corporate Code of Conduct, and leading to the company's values and beliefs.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Performs other functions as assigned by management.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success
  • High school diploma
  • 2 years experience in health-related field is required (Associates degree preferred)
  • Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist background strongly preferred
Physical Requirements:
  • Ability to work prolonged periods sitting at a workstation and working on a computer
  • Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time
  • Typical office environment including fluorescent lighting
  • Ability to work in a home office for continuous periods of time for business continuity
  • Ability to travel across the Health Plan service region for meetings and/or trainings as needed
  • Ability to hear, understand and speak clearly while using a phone, with or without a headset

What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?

  • Inpatient Pharmacy Technician

    4 weeks ago

    Syracuse, New York, United States Department Of Veterans Affairs Full time

    Summary The Inpatient Pharmacy Technician works in the inpatient section of Pharmacy Service, processing and filling inpatient medication orders (unit dose, IV admixture, ward stock, etc.) at the Syracuse VA Medical Center. Incumbent will ensure productivity is maintained at the established level for the program for which they are responsible.10%...

  • Compounding Pharmacy Technician II

    4 days ago

    Syracuse, New York, United States SUNY Upstate Medical University Full time

    Job Summary:Under the direct supervision of a licensed pharmacist, this position will prepare sterile and non-sterile medications with the focus on sterile medications including non-hazardous and hazardous medications. Stores and maintains medication inventory. Assists Clinical Pharmacists in monitoring patients. Processes Controlled Substances and...

  • Pharmacy Technician

    4 weeks ago

    Syracuse, United States CVS Health Full time

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

  • Pharmacy Technician

    5 days ago

    Syracuse, New York, United States Sapphire Recruitment, Inc. dba CPS Recruitment Full time

    Assist a rapidly growing healthcare team by aiding a pharmacy team in their daily operations. We have a contract to hire position available for a Pharmacy Technician in a Specialty Medical Office in Syracuse, NY and Homer, NY. These are busy offices who are looking for a team player to assist their organization. Qualified candidates must be able to commute...

  • Pharmacy Technician

    3 weeks ago

    Syracuse, United States Sapphire Recruitment, Inc. dba CPS Recruitment Full time

    Assist a rapidly growing healthcare team by aiding a pharmacy team in their daily operations. We have a contract to hire position available for a Pharmacy Technician in a Specialty Medical Office in Syracuse, NY and Homer, NY. These are busy offices who are looking for a team player to assist their organization. Qualified candidates must be able to commute...

  • Pharmacy Technician

    4 weeks ago

    North Syracuse, United States Rite Aid of New York Full time

    Pharmacy TechnicianTechnician in Training Contribute to our mission to improve Health and Wellness in your community. Become a Rite Aid Pharmacy Technician today! As a Pharmacy Technician in Training, you receive free training with our exclusive Rite Aid Pharmacy Technician Training & Certification Program. Your purpose is to successfully complete the...

  • Pharmacy Technician

    1 month ago

    Syracuse, United States Crouse Hospital Full time

    Pharmacy Technician performs pharmacy tasks under the supervision of the Pharmacist. Assists the Pharmacist in the activities related to medication order entry, processing, and delivery. Must be willing and able to perform all the Pharmacy Assistant duties when necessary. Assists the Pharmacist in the activities related to compounding sterile IV solutions,...

  • Pharmacy Technician

    3 weeks ago

    Syracuse, United States Crouse Hospital Full time

    Pharmacy Technician performs pharmacy tasks under the supervision of the Pharmacist. Assists the Pharmacist in the activities related to medication order entry, processing, and delivery. Must be willing and able to perform all the Pharmacy Assistant duties when necessary. Assists the Pharmacist in the activities related to compounding sterile IV solutions,...

  • Pharmacy Technician

    2 weeks ago

    North Syracuse, United States HealthDirect Pharmacy Services Full time

    Overview For over 50 years, the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC) facilities such as nursing homes and assisted living facilities, as well as correctional facilities and group homes.”. On a daily basis our team provides prescription medications, over-the-counter...

  • Pharmacy Technician

    1 month ago

    Syracuse, United States Syracuse University Full time

    This is a 9-month, full-time position The pharmacy technician is a 9-month position reporting to the Pharmacy Manager. The licensed pharmacy technician is responsible for assisting with the reconciliation of third party claims and providing medication to the SU student population. Duties include counting tablets, labeling bottles, organizing inventory,...

  • Pharmacy Technician

    3 weeks ago

    Syracuse, United States Syracuse University Full time

    This is a 9-month, full-time position The pharmacy technician is a 9-month position reporting to the Pharmacy Manager. The licensed pharmacy technician is responsible for assisting with the reconciliation of third party claims and providing medication to the SU student population. Duties include counting tablets, labeling bottles, organizing inventory,...

  • Pharmacy Technician

    5 days ago

    Syracuse, New York, United States Syracuse University Full time

    This is a 9-month, full-time positionThe pharmacy technician is a 9-month position reporting to the Pharmacy Manager. The licensed pharmacy technician is responsible for assisting with the reconciliation of third party claims and providing medication to the SU student population.Duties include counting tablets, labeling bottles, organizing inventory,...

  • Pharmacy Technician

    4 weeks ago

    Syracuse, United States Clarest Health Full time

    Join ProCare LTC Pharmacy, where healthcare meets compassion at our closed-door pharmacy in Syracuse, NY! As a division of Clarest Health, we blend personalized care with cutting-edge pharmacy services, setting the standard for excellence in long-term care. We're on the lookout for pharmacy technicians to join our team and make a difference in the lives of...

  • Pharmacy Technician

    3 weeks ago

    Syracuse, United States Clarest Health Full time

    Join ProCare LTC Pharmacy, where healthcare meets compassion at our closed-door pharmacy in Syracuse, NY! As a division of Clarest Health, we blend personalized care with cutting-edge pharmacy services, setting the standard for excellence in long-term care. We're on the lookout for pharmacy technicians to join our team and make a difference in the lives of...

  • Pharmacy Technician

    4 weeks ago

    Syracuse, United States Clarest Health Full time

    Job DescriptionJob DescriptionJoin ProCare LTC Pharmacy, where healthcare meets compassion at our closed-door pharmacy in Syracuse, NY! As a division of Clarest Health, we blend personalized care with cutting-edge pharmacy services, setting the standard for excellence in long-term care.We're on the lookout for pharmacy technicians to join our team and...

  • Pharmacy Technician

    3 weeks ago

    Syracuse, United States Clarest Health Full time

    Job DescriptionJob DescriptionJoin ProCare LTC Pharmacy, where healthcare meets compassion at our closed-door pharmacy in Syracuse, NY! As a division of Clarest Health, we blend personalized care with cutting-edge pharmacy services, setting the standard for excellence in long-term care.We're on the lookout for pharmacy technicians to join our team and...

  • Pharmacy Technician

    1 week ago

    Syracuse, United States Upstate HomeCare Full time

    Job DescriptionJob DescriptionPharmacy TechnicianRochester and Syracuse, NYJoin our TEAM!Are you passionate about healthcare and making a difference in people's lives? We're seeking a dedicated and detail-oriented pharmacy technician to join our team. Key Responsibilities:Assists pharmacists in accurately filling prescriptions and preparing...

  • Pharmacy Technician

    4 weeks ago

    North Syracuse, United States Wegmans Food Markets Full time

    Schedule: Part timeAvailability: Applying To This Requisition Allows You To Be Considered For Multiple Opportunities. Please Provide As Much Availability That Works With Your Schedule. Age Requirement: Must be 18 years or olderLocation: Syracuse, NYAddress: 3325 West Genesee StreetPay: $19 - $19.50 / hourJob Posting: 05/21/2024Job Posting End: 06/20/2024Job...

  • Pharmacy Technician

    4 weeks ago

    North Syracuse, United States Wegmans Food Markets Full time

    Schedule: Full timeAvailability: Morning, Afternoon, Evening (Includes Weekends). Age Requirement: Must be 18 years or olderLocation: Syracuse, NYAddress: 4722 Onondaga BlvdPay: $19 - $19.50 / hourJob Posting: 05/21/2024Job Posting End: 06/20/2024Job ID:R0210908we are a food market where you make the differenceAt Wegmans, we’re on a mission to help people...

  • Pharmacy Technician

    4 weeks ago

    Syracuse, New York, United States Syracuse University Full time

    Pharmacy Technician Job #: Location Syracuse, NY Pay Range: $ $18.36 per hour Hours: This is a 9-month, full-time position Standard University business hours: 8:30am - 5:00pm (academic year) Hours may vary based on operational needs. Job Type: Full-time Job Description: This is a 9-month, full-time position The pharmacy technician is a...