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Pharmacy Prior Authorization Technician
Ref No.: 18-19908
Location: Philadelphia, Pennsylvania
Job Title:         Pharmacy Prior Authorization Technician
Location:         Philadelphia, PA 19113
Duration:         3 Months
 
The primary purpose of the job is to:
  • Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician assist 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 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 appears outside of guidelines and generally accepted pharmacy standards.
  • Participates in department self-audit procedures for on-going evaluation of service.
  • Compliance with HIPAA regulations.
  • Attends required training on an annual basis.
  • Strong knowledge in specialty and non-specialty pharmaceuticals
Skills:   
  • One to three years Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
  • Minimum 35 words per minute typing speed.
  • Current PTCB or NCCT Certificate Preferred
  • High School Diploma / GED