Specialty Pharmacy Technician Prior Authorization

Become a part of our caring community and help us put health first
 The Specialty Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/technical/operational/customer support assignments. Typically works on semi-routine assignments and daily follow ups. Works closely with providers offices and insurance to troubleshoot and complete medication prior authorization requests for specialty medications.

The Specialty Operations Pharmacy Technician 2 (Prior Authorizations) will be responsible for the following:

• Efficiently manage daily worklists, conducting thorough follow-ups, and prioritizing authorization requests. 

• Research and interpret insurance claims, while utilizing a broad array of clinical and informational resources to obtain pertinent authorization information. 

• Work directly with physician offices to initiate and complete prior authorization requests, ensuring compliance with quality standards and departmental protocols. 

• Operate under minimal direction with opportunities for independent discretion and interpretation within established guidelines, supporting the delivery of high-quality patient care and operational excellence.

Use your skills to make an impact
 

Required Qualifications

• Must have an active license with the Board of Pharmacy in the state of residence (Ohio, Florida, Texas or Arizona).

• Must be certified by the Pharmacy Technician Certification Board (PTCB) or through ExCPT with an active certification.

• Must be able to research, read & interpret clinical information.

• Critical thinker who can anticipate member/customer needs and take initiative, ask the right questions and deliver the highest quality customer experience.

• Problem solver who can find viable solutions that meets member/customer needs, absent from all ideal tools and resources.

• Excellent communication skills (verbal and written).

• Experience using multiple computer applications simultaneously and strong data entry skills.

Preferred Qualifications

• Experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting.

• Mail Order Pharmacy or Specialty Pharmacy experience.

• Experience working with insurance plans and Medicare.

• Experience submitting and/or reading pharmacy claims, particularly in RxNova.

• Experience with Scriptmed.

Additional Information

Hours: The preferred hours of operation for this position will be an 8-hour shift sometime between the hours 8 a.m.-5:30 p.m. EST

• Overtime: When there is a business need, overtime will be requested. Potentially voluntary or mandatory.

• Holidays: When there is a business need to work on a holiday outside of Thanksgiving day and Christmas Day, there is the possibility of working on a holiday.

Work Style: Remote

Work at Home/Remote Requirements 
To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense

• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

HireVue Statement: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
 About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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