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Pharmacy Authorization Specialist I
2 months ago
At Prime Therapeutics, our mission is to ensure individuals receive the medications they require for improved health and well-being. This commitment inspires our every action and decision.
Position Title
Pharmacy Authorization Specialist I
Overview of Responsibilities
The Pharmacy Authorization Specialist I is responsible for assessing and approving prior authorization requests for medications from healthcare providers via telephone and/or fax, utilizing established clinical guidelines.
Key Duties
- Evaluates medication requests for appropriateness and communicates decisions to healthcare professionals, including physicians and pharmacy staff.
- Investigates, resolves, and documents outcomes of prior authorization requests within the pharmacy management system.
- Provides information on prior authorization criteria, pharmacy benefits, and formulary options to healthcare providers.
- Refers complex requests to a licensed pharmacist for further clinical evaluation or denial.
- Handles inquiries and grievances from physicians or clients, delivering both verbal and written responses.
- Performs additional tasks as needed.
- For specialists assigned to the fax queue, responsibilities include:
- Conducting detailed clinical reviews of medication coverage requests received via fax and communicating decisions within established service level agreements.
- Effectively managing multiple tasks and monitoring various queues and assignments, adapting to changing business needs.
- Possession of an active pharmacy technician license or registration in accordance with state regulations.
- If the state does not mandate an exam for licensure/registration, candidates must hold both an active pharmacy technician license and a national certification (e.g., PTCB or ExCPT).
- In states without licensure requirements, or that limit licensure to employees of dispensing pharmacies, an active national certification is necessary.
- An active pharmacist license may fulfill the requirements for a pharmacy technician.
- Experience in specialty or retail pharmacy, reimbursement processes, or within a healthcare plan setting is preferred.
- Comprehensive knowledge of specialty injectable medications, relevant disease states, formulary management, medical terminology, and diagnostic/reimbursement coding.
- Proficiency in pharmacy software systems and MS Office applications.
- Strong written and verbal communication skills.
- Ability to adhere to clinical guidelines and protocols for approving prior authorization requests.
- A minimum of six months of dispensing or retail pharmacy experience is required, or equivalent internal training may be considered.
- Capability to identify and resolve issues effectively.
Experience - Required:
Pharmacy
Education - Required:
High School Diploma or GED
Certifications
Certifications - Required:
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
Compensation for this role is competitive, with potential earnings starting at $23.39, based on experience and qualifications.
For details on our benefits and additional compensation, please visit our Benefits Page.
Prime Therapeutics LLC is an Equal Opportunity Employer and maintains a tobacco-free workplace. We welcome applications from diverse candidates and ensure that all qualified applicants receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class.
All employees must understand and comply with security responsibilities and controls specific to their roles, as well as adhere to all applicable legal, regulatory, and internal policies.
