11560 - Prior Authorization Technician

The technician shall be responsible for the authorization process of orders coming into the Pharmacy from clinics

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.

Education: High school diploma, GED or equivalent education is required

Previous Experience: Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail required.

Core Capabilities:

• Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.
• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
• Communication Skills: Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.
• Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.
• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.  
• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.
• Computer Skills:
  • Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

Certifications/Licenses:

• Pharmacy technician registration with the Florida Dept of Health in good standing required.
• 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.

Travel:   0%

Standard Work Days/Hours : Monday to Friday 9:00 AM – 5:30 PM. 

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