Call Center Clinical Pharmacy Technician - Remote

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

• You will determine appropriateness for medications and communicate decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will be evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
• You will research, resolve and document prior authorization outcomes in pharmacy system.
• You will research, resolve and document physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• You must be available to work a set schedule during training and must be available and commit to work any assigned shift between the hours of 8AM and 10PM ET daily including weekends and holidays.
• 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).
• Your performance measurements include quality, average handle time, productivity metrics, schedule adherence, and behavioral competencies.
• You will perform other duties as required.
• 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.
• You will communicate selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• As a Call Center Clinical Pharmacy Technician working remotely, you will be responsible for high volume inbound call center serving calls from Members, Pharmacies and Prescribers for Medicaid/Medicare or commercial pharmacy benefits management business.
• You will escalate requests to Pharmacist when request requires extensive clinical review or denial.
• For CPTs assigned to work the fax queue, responsibilities will also include:

• Must have an active pharmacy technician licensure or registration in accordance with state requirements.
• Active Pharmacist license supersedes requirement for CPT and/or PTCB.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• In states that do not require licensure or registration, or that restrict licensure to employees of dispensing pharmacies, must have an active national certification (e.g., PTCB or ExCPT).
• Excellent written and verbal communication skills.
• 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.).
• 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.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Ability to identify and trouble-shoot problematic issues.

Pharmacy GED, High School CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy - Pharmacy