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Pharmacy Technician - Prior Auth - MedPharm

Company: Envolve Pharmacy
Location: Tallahassee
Posted on: January 23, 2023

Job Description:

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Pharmacy Technician - Prior Auth - Part B / MedPharm - Remote - Track and triage all coverage determination requests for prior authorizations and Medicare Part B / MedPharm recipients.

Position Purpose: The Pharmacy Technician may perform duties in one or more of the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center or Prior Authorization, Medicare Part D Operations and State Health Programs Pharmacy Operations. Using established company guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits. The technician researches and resolves questions, problems or issues. May consult with Clinical Pharmacists on related issues.

Prior Authorization:

Reviews requests made by physicians and pharmacies for use of prescription drugs that are non-formulary, have prior authorization requirements, have exceeded quantity or cost limits, or require assistance in on-line processing of a prescription claim.

Assign, enter and document prior authorizations into appropriate claims processing system.

Answer phone calls for prior authorization inquiries

Researches and resolves issues using the appropriate reference material.

Responsible for knowing and interpreting pharmacy and medical benefits.

Education/Experience: High School diploma or GED required. 1 year Pharmacy Technician experience.

Highly Preferred - Managed Care and/or Hospital with Prior Authorization

License/Certification: Valid Pharmacy Technician License preferred.

Job Specific Details:

  • Track and triage coverage determination and/or prior authorization requests submitted from providers and determine if a pharmacist review is required.
  • Obtain verbal authorizations and request detailed clinical information from prescribers.
  • Approve coverage determination and/or prior authorization requests based on defined criteria.
  • Enter and document coverage determination and/or prior authorization request decisions into the PBM system and notify providers and/or members.
  • Respond to client inquiries regarding authorization approvals and PBM online applications.
  • Refer coverage determination requests for specialty drugs to delegated vendor or client for processing.
  • Contact providers for additional information to facilitate coverage determination reviews.
  • Notify physicians, providers, and members of coverage determination request decisions. Shift(s): 10am-6:30pm (In your time zone) Sunday - Thursday or Tuesday-Saturday or 10am -6:30pm Monday - Friday with a full weekend rotation (Saturday & Sunday hours are 8am - 4:30pm (EST every 3-4 weeks depending on staffing & volume.

    Location: Remote - Work-from-home

    Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Envolve Pharmacy, Tallahassee , Pharmacy Technician - Prior Auth - MedPharm, Healthcare , Tallahassee, Florida

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