Pharmacy Prior Authorization Specialist

2 weeks ago

Amherst, United States Kelly Services Full time

Kelly is currently seeking a highly skilled and dedicated Pharmacy Prior Authorization Technician in New York for a remote position for a long term project. You must be located in New York state preferable in the Buffalo, Syracuse or Rochester area.

In this role, you will be responsible for processing and reviewing prior authorization requests for both pharmacy and medical specialty drug reviews. Your expertise in pharmacy management drug policies and procedures will ensure accurate determinations and adherence to guidelines.

Snapshot:
Pay: $22- $23.50/hour depending on experience
Hours: M-F 8:30am to 5pm
Fully Remote
Project based long term position for at least 6 months with possible extension

Responsibilities:

  • Conduct initial level medication prior-authorization, exception, and medical necessity reviews to determine coverage under the member's benefit.
  • Collaborate with pharmacists and medical directors to route cases for final determination.
  • Issue verbal and written member notifications as required.
  • Review and interpret prescription and medical benefit coverage across all lines of business to identify the appropriate prior authorization review process.
  • Develop and implement process improvements to enhance efficiency in the review process.
  • Work with requesting providers, clinical pharmacists, and other internal staff to determine case eligibility and approval criteria.
  • Contact pharmacies and physician offices to obtain clarification on prior authorization requests and optimize the member experience.
  • Serve as a lead troubleshooter for the pharmacy help desk, customer care, and claim processors to coordinate pharmacy and medical claims.
  • Ensure appropriate authorization entry across all lines of business and interface with the care management system for claim payment.
  • Act as a content expert for prior authorization intake, supporting customers both internally and externally.
  • Triage prior authorization workflow, monitor work queues, and keep management informed of compliance-related issues.
  • Provide phone coverage for authorization inquiries, claim inquiries, and other related requests.
  • Support medical and pharmacy drug pricing inquiries using available resources and tools.
  • Maintain thorough knowledge of health plan contracts, policy statements, and procedures to assist staff with inquiries.
  • Perform unit-specific workflow processes in accordance with corporate policies and regulatory guidelines.
  • Prepare and assist in handling correspondence, ensuring accuracy and timeliness.
  • Collaborate with interdepartmental teams to ensure consistent and quality healthcare services.
  • Demonstrate high standards of integrity, privacy, and adherence to company policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Perform other functions as assigned by management.

Minimum Requirements:

  • High school diploma with a minimum of two years of experience in a health-related field. Associate's degree preferred.
  • Pharmacy Technician certification (CPhT), LPN, or Medical Assistant/Technologist background preferred.

Physical Requirements:

  • Ability to work prolonged periods sitting at a workstation and using a computer.
  • Ability to work while sitting and/or standing, viewing a computer, and using a keyboard, mouse, and/or phone for extended periods.
  • Typical office environment including fluorescent lighting.
  • Ability to work from a home office for continuous periods of time for business continuity.
  • Ability to travel across the Health Plan service region for meetings and training as needed.
  • Ability to hear, understand, and speak clearly while using a phone, with or without a headset.

What Happens Next

Once you apply, you'll proceed to next steps if your skills and experience look like a good fit. But don't worry—even if this position doesn't work out, you're still in our network. That means all of our recruiters will have access to your profile, expanding your opportunities even more.

Helping you discover what's next in your career is what we're all about, so let's get to work.

Apply to be a Pharmacy Prior Authorization Specialist today



As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.

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About Kelly

Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life—just ask the 300,000 people we employ each year.

Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

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