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Job Posting Title

Remote Call Center Pharmacy Technician

Job Description Summary

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Our Clinical Pharmacy Technicians will be responsible for taking inbound calls from providers, members and pharmacists regarding prior authorization services for our Medicaid and/or commercial pharmacy benefits management member populations in a remote work from home computer/call center setting full time.

Job Description

• As a Call Center Clinical Pharmacy Technician working remotely, you will be responsible for high volume inbound call center serving calls from Members, Pharmacies and Prescribers for Medicaid/Medicare or commercial pharmacy benefits management business.
• You will be evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
• Your performance measurements include quality, average handle time, productivity metrics, schedule adherence, and behavioral competencies.
• You must be available to work a set schedule during training and must be available and commit to work any assigned shift between the hours of 8AM and 10PM ET daily including weekends and holidays.
• You will determine appropriateness for medications and communicate decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will research, resolve and document prior authorization outcomes in pharmacy system.
• You will communicate selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will escalate requests to Pharmacist when request requires extensive clinical review or denial.
• You will research, resolve and document physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• You will perform other duties as required.
• For CPTs assigned to work the fax queue, responsibilities will also include:
• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.
• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).

Responsibilities

• Must have an active pharmacy technician licensure or registration in accordance with state requirements.

• If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).

• In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).

• Active Pharmacist license supersedes requirement for CPT and/or PTCB.

• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.

• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).

• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.

• Excellent written and verbal communication skills.

• Ability to follow clinical criteria and instructions to approve prior authorization requests.

• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.

• Ability to identify and trouble-shoot problematic issues.

Work Experience

Work Experience - Required:

Pharmacy

Work Experience - Preferred:

Education

Education - Required:

GED, High School

Education - Preferred:

Certifications

Certifications - Required:

CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy - Pharmacy

Certifications - Preferred:

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.