Pharmacy Technician Prior Authorization Specialist

2 days ago


Glendale, Arizona, United States Helping Hand Health Full time

Job Summary:

We are seeking a highly skilled Pharmacy Technician Prior Authorization Specialist to join our team at Helping Hand Health. As a Pharmacy Technician Prior Authorization Specialist, you will be responsible for processing and finalizing prior authorization requests within regulatory turnaround times.

Key Responsibilities:

  • Process and finalize PA requests within regulatory turnaround time (TAT).
  • Enter prior authorizations into the system and prioritize requests.
  • Check formulary alternatives, review tried and failed medications.
  • Utilize drug references and verify the drug being requested is indicated and approved for the condition.
  • Accountable to achieve prior authorization processing productivity and accuracy standards.
  • Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career path level.
  • Coordinates notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations.
  • Makes outbound calls to obtain information and answer questions about prior authorization status.
  • Follow prior authorization processing regulatory requirements and expectations.
  • Collaborates with other departments in resolving prior authorization inquiries and handling incoming calls.
  • Protects and maintains confidentiality and privacy of all prior authorization and member information.
  • Make outreach to members, pharmacies and providers to address quality related gaps in care.
  • Field pharmacy related questions from health plan members and health plan staff; appropriately escalate concerns to management in a timely manner.
  • Assist with projects such as claim trouble shooting, issue tracking, system configuration, vendor management and other project related tasks.

Requirements:

  • 2 years of experience processing prior authorizations for a health plan or Pharmacy Benefit Manager (PBM)
  • Bilingual (Spanish)
  • Exceptional customer service and professionalism.
  • Must have knowledge of pharmacy claims adjudication.
  • Must be self-motivated and willing to work effectively and efficiently.
  • Active Arizona Pharmacy Technician License or Trainee license


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