Prior Authorization Technician I

Job Title : Prior Authorization Technician I

Location : Philadelphia, PA 19113 (REMOTE)

Duration : 3-4 months (Contract)

Shift : 40 Hours Per Week / 5 Days per week

Duties :

• 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.