Adap Clinical Pharmacy Technician

ADAP Clinical Pharmacy Technician Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

• Work schedule will be Monday through Friday 11AM to 8PM ET.
• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).
• For CPTs assigned to work the fax queue, responsibilities will also include:
• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Performs other duties as required.
• Researches, resolves and documents prior authorization outcomes in pharmacy system.
• Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• Full time remote work from home with active pharmacy technician license/registration and national pharmacy technician certification.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.
• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.

• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
• Ability to identify and trouble-shoot problematic issues.
• Active Pharmacist license supersedes requirement for CPT and/or PTCB.
• Excellent written and verbal communication skills.
• If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Must have an active pharmacy technician licensure or registration in accordance with state requirements.

Pharmacy GED, High School CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy - Pharmacy Potential pay for this position ranges from $15.29 - $22.93 based on experience and skills. Pay range may vary by 8% depending on applicant location.