Job Overview
We invite applications for a proficient and meticulous Pharmacy Technician specializing in Prior Authorization, to join our dedicated healthcare team. This remote position plays a vital role in liaising with healthcare providers to efficiently process prior authorization and drug benefit exception requests while ensuring adherence to Medicare Part D regulations. Your commitment to quality service will directly impact the well-being of our patients and providers.
Key Responsibilities
- Collaborate with healthcare providers to evaluate and process prior authorization and drug benefit exception requests in compliance with Medicare Part D CMS guidelines.
- Utilize plan criteria based on directives and investigate relevant details across diverse channels.
- Conduct proactive outreach via phone to providers to collect additional information, ensuring requests are processed accurately and promptly.
- Assume ownership of cases, guaranteeing completion of all required actions to resolve and close requests satisfactorily.
- Identify and address issues to maintain a seamless workflow from initiation to resolution.
- Provide telephonic assistance to resolve coverage requests as necessary.
- Escalate complex cases to clinical pharmacists or management when appropriate.
- Uphold compliance with CMS and internal departmental standards at all times.
Required Skills
- Exceptional attention to detail and a strong dedication to quality standards.
- Excellent verbal and written communication skills, with an unwavering commitment to maintaining patient confidentiality.
- Proficient in navigating computer systems and familiar with Windows-based applications.
- Ability to follow directions and adapt within an evolving work environment.
- Strong problem-solving capabilities coupled with a proactive mindset towards challenges.
- Highly organized, with the ability to prioritize tasks effectively in a fast-paced and high-pressure setting.
- Exceptional telephone etiquette and communication proficiency.
- Familiarity with medical and pharmacy terminology is advantageous.
- Ability to interpret and apply diverse work instructions while adapting to procedural changes.
- Strong analytical skills, capable of interpreting general business correspondence and regulatory guidelines.
- Consistently meet quality and production standards.
- Demonstrate urgency in meeting deadlines and resolving issues.
- Intellectual curiosity and a desire to comprehend the business for accurate results.
Qualifications
- High School Diploma or equivalent is required; further education in a related discipline is considered a plus.
- Previous experience in healthcare or associated fields is preferred, with familiarity in Medicare Part D regulations being beneficial.
Career Growth Opportunities
This role presents an exceptional opportunity to acquire valuable skills in healthcare processing and compliance, with avenues for professional development as you navigate complex healthcare cases.
Why Join Us?
This is a compelling opportunity to become an integral part of a dynamic team dedicated to ensuring patients receive the necessary care they need. If you excel in a collaborative, fast-paced environment and have a passion for problem-solving, we encourage you to submit your application.
Employment Type: Full-Time
