Pharmacy Technician/ Prior Authorization

Pharmacy Technician/Prior Authorization

Contract role for 3 months with a strong possibility of extension

Location: 200 Stevens Philadelphia, PA 19113

Experience with retail pharmacies, Call centers, Customer Care will be considered Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician I assists in the prior authorization process.

• Responsible for reviewing and approving physician or member inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.

• Responsible for accurate and timely data entry of prior authorization requests within the Prior authorization system to meet all client-specific requirements and contractual agreements.

• Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner.

• Responsible for receiving prior authorization requests telephonically while utilizing multiple systems to confirm the accuracy of the information being provided.

• Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered. Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.

• Maintains a balance of productivity, quality, and timeliness of job accountabilities.

• Participates in department self-audit procedures for ongoing evaluation of service.

• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity. Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.

• Compliance with HIPAA regulations and AMFC policies and procedures.