Your Role:
The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Pharmacy Technician, Intermediate, will report to the Operations Supervisor. In this role you will resolve outpatient pharmacy benefit coverage inquiries, including prescription claim processing problems, and communication of drug formulary guidelines and alternatives.
In this role, you will:
- Coordinate, assist in, and support implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit
- Evaluate prior authorization requests based on medication policy and operational principles
- Provide drug usage history and other pertinent pharmacy benefit related inquiries to internal business partners to assist in case specific reviews and drug evaluations
- Communicate with the physician, physician’s office staff, pharmacies, and internal business partners to assist with accurate and efficient resolution of pharmacy benefit inquiries
- Clearly communicate formulary alternatives and prior authorization criteria, and discusses pharmacy benefit coverage when required
Your Knowledge and Experience:
- Requires a Certified Pharmacy Technician license
- Requires at least 2 years of pharmacy related experience and training; or equivalent combination of education and experience
- Demonstrated ability encompasses basic understanding of internal procedures and policies needed to ensure effective execution of assigned tasks
- Ability to multi-task, set priorities, and manage time effectively
- Strong phone and verbal communication skills along with active listening
Compensation:
The pay rate range above is the base hourly pay range that Aditi Consulting reasonably expects to pay someone for this position (compensation may vary outside of this range depending on a number of factors, including but not limited to, a candidate’s qualifications, skills, competencies, experience, location and end client requirements).
Benefits and Ancillaries:
Medical, dental, vision, PTO benefits and ancillaries may be available for eligible Aditi Consulting employees and vary based on the plan options selected by the employee.
Aditi Consulting LLC uses AI technology to engage candidates during the sourcing process. AI technology is used to gather data only and does not replace human-based decision making in employment decisions.
