About this role
Location
Remote PositionHiring Range:
$16.00 - $30.21
Position Summary
The Prior Authorization Technician shall be responsible for the authorization process of orders coming into the Pharmacy from AON clinics.
Key Performance Areas
KPA 1 – Prior and REMS Authorizations
- Submit prior authorizations on behalf of physicians
- Follow up on submitted PA requests when no response is received
- Monitor each PA through the process until approved/denied, and inform patient, staff and clinic as indicated.
- Responsible for assisting the clinicians in obtaining Celgene authorization and confirmation numbers.
KPA 2 – Appeals
- Will review and initiate prior authorization appeal services to include first level appeal reviews. Will coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required.
KPA 3 – Backup to pharmacy staff
- Will monitor daily activities and provide backup support where needed, including PAP, SP follow-ups, BV and claims adjudication as needed.
KPA 4 – Education & Training
- Responsible for keeping up on all applicable training and education for maintenance of permit.
- Will train staff on PA processes.
KPA 5 – Customer Service
- Incoming and outgoing calls/emails to patients. Routing of calls to appropriate staff. Answering patient/clinic questions regarding delivery status, Rx updates, etc.
- SP follow-up to assure orders are being processed efficiently.
- Scheduling deliveries.
Position Qualifications
Education
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High school diploma, GED or equivalent education is required
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Minimum Relevant Experience
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Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail required.
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Certifications/Licenses
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Pharmacy technician registration with the Florida Dept of Health in good standing required.
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Valid state Driver’s License for travel to satellite offices and offsite meetings. Compliance with the company Driver Safety Operations and Motor Vehicle Records Check Policy is required.
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Travel: 0%