Prior Authorization Technician I

Company: Amerihealth Caritas Health Plan
Location: Burlington
Posted on: April 30, 2021

Job Description:

PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help customers, doctors and patients use effective medication therapy to improve health and wellness. For more than 15 years, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees; more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians, and in the services we provide. PerformRx is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies. Available to candidates Nationwide Responsibilities: Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Prior Authorization Technician I assists in the prior authorization process. * Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner for pharmacy and medical billing. Responsible for making outbound calls/receiving inbound calls, speaking with physicians' offices for additional information or clarifications needed to process prior authorization request. * Supports the 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. * Keeps abreast of industry trends and regulatory changes in the pharmacy industry and incorporates knowledge in the performance of job duties. Identifies problems in process/procedures or services and makes recommendations for improvements. Maintains a balance of productivity, quality and timeliness of job accountabilities. Participates in department self-audit procedures for on-going evaluation of service. * Maintains and updates internal databases. Enters application information, prior authorizations and other relevant data. Ensures database information and appended files are current and accessible to staff. Generates reports and other information requested on a scheduled/as needed basis. * Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times. * Performs other related duties as assigned * Attends required training on an annual basis * Adheres to AMFC policies and procedures * Must be available to work weekends and holidays. * * Multiple shift times available between the hours of 8:00 a.m. EST to 9:00 p.m. EST. * Education/Experience: * High School Diploma or equivalent required * Active/current National Pharmacy Technician Certification (i.e., ExCPT, NCCT, PTCB) or ability to obtain one within the first twelve (12) months of employment required * Current/recent Pharmacy Benefit Manager (PBM), managed care, hospital pharmacy, long-term care (LTC) pharmacy, home infusion pharmacy, and/or retail pharmacy experience preferred * Knowledge in pharmacy practices, procedures and precedents; ability to read and understand pharmaceutical information * Working knowledge of drug dosage forms, drug strength, generic & trade name equivalent * Demonstrates knowledge of Federal & State laws/regulations regarding provisions of pharmaceutical services * Strong knowledge in specialty pharmaceuticals * Ability to multi-task and prioritize work * Ability to comprehend and follow established office routines, policies and procedures * Customer service and interpersonal skills * Ability to adjust based on business/department needs * Demonstrated courteous and professional behavior * Proficient PC skills in a windows based environment * Ability to identify problems including complex issues and determine solutions, both independently or in a team/group setting * Must be organized, detail-oriented and have excellent communication skills (listening, verbal, written, grammar)

Keywords: Amerihealth Caritas Health Plan, Burlington , Prior Authorization Technician I, Professions , Burlington, North Carolina