Clinical Pharmacy Technician I- Prior Authorizations

2 weeks ago

Dublin, Dublin City, Ireland Highmark Health Full time
Company :

Allegheny Health Network

Job Description :

JOB SUMMARY

This position is eligible for a $5,000 sign on bonus for a 1-year commitment.

This position supports the network centralized prior authorization department. Coordinates and administers the effective and efficient processing of the pharmacy benefits prior authorization process, ensuring that pharmacy benefits are administered in accordance with all regulatory agency requirements.

ESSENTIAL RESPONSIBILITIES

  1. Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%)
  2. Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines. (20%)
  3. Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Corporate Pharmacy Department. (20%)
  4. Maintain regulatory compliance and resolves all cases within predetermined timeframes. (15%)
  5. Responsible for all preauthorization entries into applicable databases (i.e. internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary. (20%)
  6. Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others. (5%)
  7. May perform other non-clinical duties as required by management and department needs.

EXPERIENCE

Required

  • 2 years of experience as a Pharmacy Technician in a hospital, retail, or managed care setting.

Preferred

  • None

SKILLS

  • Strong knowledge of medical and pharmaceutical terminology.
  • Strong verbal and written communication skills.
  • Well organized, paying close attention to detail.
  • Ability to identify and resolve problems.
  • Ability to handle multiple priorities in a timely manner.
  • Strong interpersonal skills.
  • Ability to work independently or in a team environment.
  • Customer oriented.
  • Proficient with Microsoft Office products (i.e. Word, Excel, PowerPoint, etc.).

EDUCATION

Required

  • Associate degree.

Preferred

  • None

LICENSES or CERTIFICATIONS

Required

  • Certified Pharmacy Technician (CPhT) from Pharmacy Technician Certification Board.

Preferred

  • None

Language (Other than English): None

Travel Requirement: 0% - 25%

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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