Job Title: Pharmacy Technician

Job Description

This role involves working as a Pharmacy Technician with Medicare and Medicaid patients, primarily focusing on Medicare. The position requires handling Prior Authorizations through two main functions: intake and tech review. Initially, the role will focus on the intake of medpharm prior authorization, setting up the PA in their systems, and sending it to a review tech. Training will be provided for the tech review, where the technician will receive the PA case from the intake team, review it to determine coverage, and make clinical determinations on medication approvals or denials.

Responsibilities

• Conduct intake of medpharm prior authorizations and set up PA in systems.
• Send authorizations to review tech for further processing.
• Receive PA cases from intake team and review coverage criteria.
• Make clinical determinations on medication approval or denial based on criteria, SOPs, insurance, and medical documents.
• Read extensively over criteria, SOPs, insurance documents, and medical documents to determine eligibility.

Essential Skills

• Pharmacy Technician certification
• Experience in pharmacy and managed care
• Data entry skills
• Prior Authorization experience
• Proficiency in computer skills
• Ability to work remotely and independently
• Customer service skills
• CPht certification

Additional Skills & Qualifications

• Experience in managed care
• Ability to handle phone customer service
• Capability to control and redirect conversations as needed

Work Environment

This position is 100% remote, requiring work in a closed door setting with limited distractions and compliance with HIPAA regulations. A strong WiFi connection is necessary. The training schedule is Monday to Friday, 10:00 AM to 6:30 PM EST. Post-training, the work schedule offers flexibility with options to work Sunday through Thursday or Tuesday through Saturday. Preferred hours for Sunday through Thursday are 12:00 PM to 8:30 PM or 12:30 PM to 9:00 PM EST, with Sunday from 8:00 AM to 4:30 PM EST. For Tuesday through Saturday, preferred hours are 12:30 PM to 9:00 PM EST, with Saturday from 8:00 AM to 4:30 PM EST. Lunch breaks range from 30 minutes to an hour.