Prior Authorization Technician I

About This Role

Process administrative prior authorization requests, handle inquiries from pharmacies, physicians' offices, and members, and maintain confidentiality of all PHI.

Responsibilities

• Take administrative prior authorization (PA) calls from pharmacies, physicians' offices, and members with a goal of first-call resolution
• Place call notes in appropriate areas every time a PA request is handled
• Work closely with pharmacies, providers, and members to resolve questions or issues involving PAs
• Respond promptly, professionally, and courteously to inquiries regarding administrative prior authorizations
• Clearly identify problems, analyze situations, and rectify concerns using established procedures
• Handle difficult people and problems by resolving matters in an effective and timely manner
• Provide support to pharmacies having difficulty processing claims
• Ensure all PAs are placed into RxClaim correctly and in a timely manner
• Apply appropriate policies, procedures, and eligibility and benefit policies
• Maintain confidentiality of all PHI in compliance with state and federal law

Requirements

• 2+ years of pharmacy related experience
• 2+ years of customer service related experience
• Proficiency in Microsoft applications (MS Office Suite knowledge)
• Strong telephone, verbal, and written communication skills
• Knowledge of customer service principles and practices
• Time management skills
• Ability to multi-task
• Claim system knowledge

Qualifications

• At least 2 years of pharmacy related experience and 2 years of customer service related experience

Nice to Have

• Registered Pharmacy Technician within the state of FL

Skills

* Required skills

Benefits