Specialty Pharmacy Technician Prior Authorization

About the role

The Specialty Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/technical/operational/customer support assignments. Typically work on semi-routine assignments and daily follow ups. Work with providers offices and insurance to troubleshoot and complete medication prior authorization requests for specialty medications.

Responsibilities

• Manage daily worklists, conducting follow-ups, and prioritizing authorization requests.
• Research and interpret insurance claims, while using a broad array of clinical and informational resources to obtain relevant authorization information.
• Work directly with physician offices to initiate and complete prior authorization requests, ensuring compliance with quality standards and departmental protocols.
• Operate with opportunities for independent discretion and interpretation within established guidelines, supporting the delivery of high-quality patient care and operational excellence.

Requirements

• Active license with the Board of Pharmacy in the state of residence (Ohio, Florida, Texas or Arizona).
• Certified by the Pharmacy Technician Certification Board (PTCB) or through ExCPT with an active certification.
• Ability to research, read & interpret clinical information.
• Critical thinker who can anticipate member/customer needs and take initiative, ask the right questions and deliver the highest quality customer experience.
• Problem solver who can find viable solutions that meets member/customer needs, absent from all ideal tools.
• Experience using multiple applications simultaneously and data entry skills.

Preferred Qualifications

• 2+ years of experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting.
• Mail Order Pharmacy or Specialty Pharmacy experience.
• Experience working with insurance plans and Medicare.
• Experience with RxNova and Scriptmed.

Additional Information

• Hours: The preferred hours of operation for this position will be an 8-hour shift sometime between the hours 8 a.m.-5:30 p.m. EST.
• Overtime: When there is a business need, overtime will be requested.
• Holidays: When there is a business need to work on a holiday outside of Thanksgiving day and Christmas Day, there is the possibility of working on a holiday.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Pay Range

$40,000 - $52,300 per year

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana company

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM).