Clinical Pharmacy Technician (Remote)

Position Summary

Our Clinical Pharmacy Technician processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments. Processes claims and enters prior authorization data necessary for claims adjudication. Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines.

Major Responsibilities

• Enter prior authorizations into the system and prioritize requests.
• Check formulary alternatives and review tried and failed medications.
• Utilize drug references and verify the drug being requested is indicated and approved for the condition.
• Document all related information regarding the PA approval or non-approval.
• Conform to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision-making.
• Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Analyze, research, and resolve prior authorization processing issues, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from supervisor or clinical pharmacists; and referring unique or high dollar requests to supervisor according to guidelines.
• Cover the floor without a supervisor, including for escalated calls or emails.

Requirements

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Moderate-to-high level of medication and disease state knowledge within the scope of pharmacy practice.
• Personal computer literacy and high competency in using Microsoft Word, Excel, Adobe, etc.
• Strong organizational skills with attention to detail.
• Strong oral and written communication skills.
• Excellent critical thinking capabilities with a strong attention to detail.
• Exceptional customer service skills.
• One-year prior authorization experience preferred.
• Health plan or Pharmacy Benefit Manager experience preferred.
• High school diploma or equivalent.
• Active Certified Pharmacy Technician (State or National License).