Job Title: Certified Pharmacy Technician - Prior Authorization

Job Description

The Certified Pharmacy Technician for Prior Authorization will be responsible for processing coverage determinations, including prior authorization and exception requests, to the Plan formulary. This role involves receiving, researching, documenting, and processing these determinations promptly, as required by regulatory standards. Additionally, this position requires effective communication of decisions with providers, members, and internal staff.

Responsibilities

• Receive, review, process, and respond to coverage determinations to the Plan formulary in accordance with departmental guidelines and federal regulations.
• Provide support to internal and external customers, serving as a representative for the department.
• Maintain coverage determination policies and procedures and assist with policy and procedure education for customers.
• Manage responsibilities that may require evening and weekend work, as well as overtime, to meet CMS requirements.

Essential Skills

• 3-5 years of experience as a Certified Pharmacy Technician.
• Experience with prior authorization.
• Current Pharmacy Technician License in good standing with the Alabama State Board of Pharmacy.
• Certified Pharmacy Technician (CPhT) from the Pharmacy Technician Certification Board or the National Healthcare Association.
• Excellent customer service skills in written and verbal communication.
• Basic computer skills.
• Ability to work overtime and share responsibilities during after-hours, holidays, inclement weather, and weekends.

Additional Skills & Qualifications

• Bachelor’s Degree or equivalent work experience.
• Customer service or call center experience.
• Experience in a physician's office.
• Experience with Health Plan or PBM.

Work Environment

The role offers remote work opportunities, transitioning to mostly remote after successful training with occasional in-office days. The office environment includes working in a cubicle within a small, busy department. The dress code is business casual.