Job Description:
The Tech I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The Tech I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Tech I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials.
Responsibilities:
- This position takes in-coming calls from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process.
- Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.
- In order to be successful in this role you will need proficiency pronouncing drug names and diagnosis and recognizing medical terminology.
- As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills.
- This position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
Experience:
- 1+ years' experience in customer service or call center environment.
- Prior Authorization ExperienceMust be able to work from home.
- Have high speed internet.
Preferred Qualifications:
- Previous experience in pharmacy or healthcare industry.
- Associate or bachelor’s Degree.
- Pharmacy Technician License
Skills:
Education:
- Verifiable High School diploma or GED is required.Job Title: Pharmacy Tech Location: Fully remote Duration: 12 months contract
Job Description:
- The Pharmacy tech takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process.
- Maintains complete, timely and accurate documentation of reviews.
- Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
- The pharmacy Tech will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
- Responsibilities:
- Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards.
- Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
- Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
- Identify and elevate clinical inquiries to the pharmacist team as appropriate
- Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc.
- Experience:
- 1-3 years of experience in customer service or call center environment managing high volume calls.
- 6 months of experience working in PBM on managed care environments
- Skills:
- Prior Authorization
- Medicare and Medicaid
- Call handling experience.
- Education:
- Pharmacy Tech license
- PTCB Certification
- High School diploma or GED
- About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
