Pharmacy Authorization Specialist
9 hours ago
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.
- 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.
- 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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