Prior Authorization Technician

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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

• High school diploma, GED or equivalent education is required

Minimum Relevant Experience

• Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail 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%

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