Prior Authorization Technician II

3 weeks ago

Lakeland, United States WellDyne Full time
Summary

The Prior Authorization Tech II is responsible for starting all clinical prior authorization requests via telephone or email which includes creating and faxing cases for prior authorization while maintaining complete, timely and accurate documentation of all requests. Individual will also complete PA requests via telephone with appropriate staff at prescriber’s office. Individual also works closely with pharmacies, providers, and members to resolve any questions or issues involving prior authorizations while maintaining confidentiality of all PHI. This position requires strong telephone, verbal and written communication skills, knowledge of customer service principles and practices, and time management skills with the ability to multi-task. Individual must also be proficient in Microsoft applications.

Essential Duties and Responsibilities
  • Responsible for starting clinical prior authorization requests via telephone or email.
  • Support prior authorization call center via administrative and clinical prior authorization support lines.
  • Creates and faxes cases for prior authorization, maintaining complete, timely and accurate documentation of all prior authorization requests.
  • Completes prior authorization request via telephone with appropriate staff at prescriber’s office by answering questions based on protocols when possible.
  • Works closely with pharmacies, providers, and members to resolve any questions or issues involving prior authorizations.
  • Responds in a prompt, professional, and courteous manner to pharmacy, provider and member inquiries regarding administrative prior authorizations.
  • Ability to clearly identify problem, analyze situation, and rectify pharmacy, provider, or member concerns using established procedures.
  • Ability to handle difficult people and problems by resolving matters in an effective and timely manner.
  • Responsible for clearing and following up on all messages left on prior authorization voicemail box in a timely manner.
  • Applies appropriate policies, procedures, and eligibility and benefit policies.
  • Maintains confidentiality of all PHI in compliance with state and federal law.
  • Consistently meets established productivity, schedule adherence, and quality standards, while maintaining a good attendance record.
  • Other duties as assigned.
Education and Experience
  • Pharmacy Technician Certification Required
  • At least 2 years of pharmacy related experience
  • At least 2 years of customer service related experience
  • MS Office Suite knowledge (Which includes the ability to learn new and complex computer system applications)
Knowledge, Skills, and Abilities
  • Strong telephone, verbal, and written communication skills
  • Knowledge of customer service principles and practices
  • Time Management Skills
  • Team work and team building skills
  • Ability to work independently within team environment with little direct supervision
  • Ability to work in a high pace, stress environment
  • Ability to remain focused and productive each day though tasks may be repetitive
  • Strong attention to detail and effective follow-up skills
  • Ability to multi-task
  • Claim system knowledge
  • Positive attitude with excellent customer service mindset demonstrating WellDyneRx commitment to incredible service
  • Computer proficiency to navigate required databases and operate in required software packages
  • Interested in working with people with a strong desire to help resolve problems
  • Ability to work under pressure
  • Creative problem solver and effective at conflict resolution
  • Ability to sit at a computer using phone and headset for length of shift with breaks and lunch away from desk assigned per length of given shift
  • Demonstrated ability to handle problems tactfully
WellDyne Can Offer You
  • Medical, Dental and Vision Benefits
  • Medical Savings Account Options with Company match
  • 401K after 90 days of employment
  • Employee Assistance Program
  • Life and Supplemental insurance
  • Educational Reimbursement
  • Paid Time Off

Work Environment / Physical Demands

This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients. Some travel may be required.

EOE M/F/D/V

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