Prior Authorization Technician I / Pharmacy Authorization Technician

Job Description

Job Description

Prior Authorization Technician I

Philadelphia PA

3 Months Contract

The Prior Authorization Technician I assists in the prior authorization process.

Reports directly to the Supervisor, Prior Authorization Technicians

Processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications

Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable

Utilizes member claims history during the prior authorization review process

Makes outbound calls to obtain additional information needed to process prior authorization requests

Submits authorizations to pharmacy and medical claims processors

Forwards prior authorization requests to a pharmacist when necessary

Makes appropriate referrals to other clinical programs

Assists in directing appropriate requests to in network providers

Receives inbound calls from the customer care center with prior authorization related inquiries

Assist with Appeals processing as assigned

Ability to multitask between various tasks and systems while maintaining required productivity and quality levels

Ability to make changes in a fast paced environment

Strong knowledge of specialty and non-specialty pharmaceuticals

Performs other job related duties and projects as assigned

Attends required training on an annual basis.

Adheres to corporate and departmental policies and procedures.

Available to work weekends and holidays.

Skills : 1 to 3 Years

Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.

Minimum 35 words per minute typing speed.

Education :

High School Diploma / GED

Certified Pharmacy Technician (PTCB or NHA) Required

#TB_HC

Company Description

Founded in 2002 by three former Monster.com executives; TalentBurst is an award-winning full-service Staffing Firm working directly with Fortune 500 companies in the US and Canada. We specialize in Contract and Contract to Permanent roles across many industries and have direct / contractual relationships with all our clients. Please visit our website www.talentburst.com or come meet us at our offices in Natick, MA, Miami, FL, Christiansburg, VA, Vineland, NJ, Houston, TX & downtown San Francisco, CA

Company Description

Founded in 2002 by three former Monster.com executives; TalentBurst is an award-winning full-service Staffing Firm working directly with Fortune 500 companies in the US and Canada. We specialize in Contract and Contract to Permanent roles across many industries and have direct / contractual relationships with all our clients. Please visit our website www.talentburst.com or come meet us at our offices in Natick, MA, Miami, FL, Christiansburg, VA, Vineland, NJ, Houston, TX & downtown San Francisco, CA