Prior Authorization Technician I

About the role

Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help customers, doctors and patients use effective medication therapy to improve health and wellness. For more than 15 years, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees - more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians - and in the services we provide. PerformRx is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies. *** OPEN TO CANDIDATES NATIONWIDE ***

Responsibilities

• Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable
• Utilizes member claims history during the prior authorization review process
• Makes outbound calls to obtain additional information needed to process prior authorization requests
• Submits authorizations to pharmacy and medical claims processors
• Forwards prior authorization requests to a pharmacist when necessary
• Makes appropriate referrals to other clinical programs
• Assists in directing appropriate requests to in network providers
• Receives inbound calls from the customer care center with prior authorization related inquiries
• Assist with Appeals processing as assigned
• Ability to multitask between various tasks and systems while maintaining required productivity and quality levels
• Ability to make changes in a fast-paced environment
• Strong knowledge of specialty and non-specialty pharmaceuticals
• Performs other job-related duties and projects as assigned
• Attends required training on an annual basis
• Adheres to corporate and departmental policies and procedures
• Available to work weekends and holidays

Education/Experience

• High School Diploma or equivalent
• Active/current National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one within the first twelve (12) months of employment
• Current/recent Pharmacy Benefit Manager (PBM), managed care, hospital pharmacy, long-term care (LTC) pharmacy, home infusion pharmacy, and/or retail pharmacy experience preferred

Requirements

• Knowledge of pharmacy practices, procedures and precedents; ability to read and understand pharmaceutical information
• Working knowledge of drug dosage forms, drug strength, generic & trade name equivalent
• Demonstrate knowledge of Federal & State laws/regulations regarding provisions of pharmaceutical services
• Strong knowledge in specialty pharmaceuticals
• Ability to multi-task and prioritize work
• Ability to comprehend and follow established office routines, policies and procedures
• Customer service and interpersonal skills
• Ability to adjust based on business/department needs
• Demonstrated courteous and professional behavior
• Proficient PC skills in a windows based environment