Job Description

We are seeking a dedicated Certified Pharmacy Technician (CPhT) with managed care experience to join our client’s team as a Prior Authorization Specialist . In this role, you will be responsible for managing prescription prior authorization requests, ensuring accurate data entry and assisting with clinical and customer service support. This is a full-time, remote position starting within 10 days of offer acceptance.

• Receive, review and provide accurate data entry of prescription prior authorization requests
• Conduct outreach calls to obtain necessary clinical criteria forms and progress notes
• Assist with the onboarding of new employer groups and new membership
• Communicate drug formulary guidelines, prior authorization criteria and plan benefit design to participants, providers and pharmacies
• Resolve escalated participant issues and claims-related issues
• Utilize basic Microsoft Excel functions and track metrics
• Support ongoing clinical programs and assist members with obtaining assistance programs
• Provide customer service support, including handling member complaints and escalations

• 2+ years of experience as a pharmacy technician
• Certified Pharmacy Technician (CPhT) License required
• Prior authorization experience within a pharmacy benefit manager (PBM) setting required
• Experience with resolving rejected claims and third-party claims adjudication systems
• Intermediate Microsoft Excel skills preferred
• Patient, provider, and pharmacy customer service experience preferred

• Preferred fluency in Spanish
• Strong communication, analytical and organizational skills
• Detail-oriented with a focus on providing excellent customer service
• Ability to interact effectively with patients, providers and coworkers

If you're a qualified Certified Pharmacy Technician with experience in prior authorizations and customer service, and you're excited about this remote opportunity, we encourage you to apply today! We look forward to hearing from you.

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