Pharmacy Authorization Specialist

9 hours ago


Lansing, Michigan, United States Tekwissen Full time
Job Title: Prior Authorization Specialist

At Tekwissen Group, we are seeking a highly skilled Prior Authorization Specialist to join our team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our clients receive timely and accurate authorization for their pharmacy claims.

Responsibilities:
  • Process prior authorization requests under the supervision of a Clinical Pharmacist.
  • Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests.
  • Analyze written, faxed, and verbal inquiries which leads to entry of pharmacy authorizations into the system.
  • Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool.
  • Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.
Requirements:
  • High School Graduate or GED equivalent required.
  • Two (2) years of college preferred.
  • Two (2) years' experience in retail or hospital Pharmacy required.
  • Pharmacy Technician Certification (PTCB) preferred.
Skills and Knowledge:
  • Knowledge of pharmacy claims processing.
  • Understanding of formularies and utilization management edits.
  • Familiarity with Medicare Guidelines and Timeframes.
  • Computer Literate (Microsoft Office Products).

We are an equal opportunity employer supporting workforce diversity. If you are a motivated and detail-oriented individual with a passion for pharmacy and healthcare, we encourage you to apply for this exciting opportunity.



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